Combination therapy of tetracyclic quinolone analogs for treating cancer

ABSTRACT

The present invention provides methods, compositions, and combinations for treating cancer via combined use of a compound of formula I or a pharmaceutically acceptable salt, ester, solvate and/or prodrug thereof, wherein A, Q, n, m, R7, R8, V, X1, X2, X3, X4, X5, X6, and X7 are as defined herein, and at least one therapeutically active agents selected from immunotherapeutics, anticancer agents, and anti-angiogenics.

CROSS-REFERENCE TO RELATED PATENT APPLICATIONS

The present application is a continuation of U.S. application Ser. No.16/251,866, filed Jan. 18, 2019, which is a divisional of U.S.application Ser. No. 15/347,656, filed Nov. 9, 2016, which claimspriority to, and the benefit of U.S. Provisional Patent Application Ser.No. 62/258,211, filed Nov. 20, 2015, the disclosures of which are herebyincorporated by reference in their entireties for all purposes.

FIELD OF THE DISCLOSURE

The present invention generally relates to a combination therapy fortreating cancer and tumors.

BACKGROUND OF THE DISCLOSURE

A variety of tetracyclic quinolone compounds have been suggested tofunction by interacting with quadruplex-forming regions of nucleic acidsand modulating ribosomal RNA transcription. See, for example, U.S. Pat.Nos. 7,928,100 and 8,853,234. Specifically, the tetracyclic quinolonecompounds can stabilize the DNA G-quadruplexes (G4s) in cancer cells andthereby induce synthetic lethality in cancer cells. Since treatment ofcells with G4-stabilizing agents can lead to the formation of DNA doublestrand breaks (DSBs), DSB formation induced by G4-stabilizingligand/agent (such as the tetracyclic quinolones) treatment would bemore pronounced in cells genetically deficient in, or chemicallyinhibited in, repair pathways including both non-homologous end joining(NHEJ), homologous recombination repair (HRR). Furthermore, thetetracyclic quinolone compounds selectively inhibit rRNA synthesis byPol I in the nucleolus, but do not inhibit mRNA synthesis by RNAPolymerase II (Pol II) and do not inhibit DNA replication or proteinsynthesis. For example, it is suggested that targeting RNA polymerase I(Pol I) to activate p53 through the nucleolar stress pathway may resultsin selective activation of p53 in tumor cells. The p53 protein normallyfunctions as a tumor suppressor by causing cancer cells toself-destruct. Activating p53 to kill cancer cells is a well validatedanticancer strategy and many approaches are being employed to exploitthis pathway. Selective activation of p53 in tumor cells would be anattractive method of treating, controlling, ameliorating tumor cellswhile not affecting normal healthy cells. The aforementioned tetracyclicquinolones are disclosed in U.S. Pat. Nos. 7,928,100 and 8,853,234, andthe contents of this publication are herein incorporated by reference intheir entirety for all intended purposes.

Despite the recent development of anti-cancer agents, there is still astrong need for developing effective novel cancer therapy.

SUMMARY OF THE DISCLOSURE

In one embodiment, the present invention provides a pharmaceuticalcombination comprising a tetracyclic quinolone compound having thestructure of formula (I);

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

X¹ is CH or N;

X², X³, X⁴, X⁵, X⁶ and X⁷ independently are NR⁴, CH₂, CHQ or C(Q)₂,provided that zero, one or two of X², X³, X⁴, X⁵, X⁶ and X⁷ are NR⁴;

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², or —R³;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R², —SR²,—OR², or —R³;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing one additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl;

R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, orC2-C10 heteroalkenyl, each of which may be optionally substituted withone or more halogens, ═O, or an optionally substituted 3-7 memberedcarbocyclic or heterocyclic ring; or in —NR⁷R⁸, R⁷ and R⁸ together withN may form an optionally substituted azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember;

m is 0, 1, 2, 3 or 4; and

n is 0, 1, 2, 3, 4, or 5;

and at least one additional therapeutically active agent selected fromthe group consisting of immunotherapeutic agents, anticancer agents, andangiogenic agents.

In another embodiment, a pharmaceutical combination is providedcomprising a therapeutically effective amount of a compound of formula(II);

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², or —R³;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R², —SR²,—OR², or —R³;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing an additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl;

m is 0, 1, 2, 3 or 4;

n is 0, 1, 2, 3, 4 or 5; and

p is 0, 1, 2 or 3;

and at least one additional therapeutically active agent selected fromthe group consisting of immunotherapeutic agents, anticancer agents, andangiogenic agents.

In one embodiment, a pharmaceutical combination is provided comprising atherapeutically effective amount of a compound of formula (III);

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², or —R³;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR³R², —SR²,—OR², or —R³;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing an additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl;

R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, orC2-C10 heteroalkenyl, each of which may be optionally substituted withone or more halogens, ═O, or an optionally substituted 3-7 memberedcarbocyclic or heterocyclic ring;

m is 0, 1, 2, 3 or 4; and

n is 0, 1, 2, 3, 4 or 5;

and at least one additional therapeutically active agent selected fromthe group consisting of immunotherapeutic agents, anticancer agents, andangiogenic agents.

In one embodiment, a pharmaceutical combination is provided comprisingCompound A and at least one additional therapeutically active agent.

In one embodiment, a pharmaceutical combination is provided comprising acompound of formula (I) and at least one additional therapeuticallyactive agent in a single dosage form or in separate dosage forms. Inanother embodiment, the pharmaceutical combination where the compound offormula (I) and at least one additional therapeutically active agent arein separate dosage forms are administered by the same mode ofadministration or a different mode of administration. In one embodiment,the separate dosage forms of a pharmaceutical combination providedherein, are co-administered by simultaneous administration, sequentialadministration, overlapping administration, interval administration,continuous administration, or a combination thereof.

In one embodiment of the present invention, a pharmaceutical combinationis provided comprising a compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or salts,solvates, esters and/or prodrugs thereof and at least one additionaltherapeutically active agent. In some embodiments, the additionaltherapeutically active agent is an immunotherapeutic agent, ananticancer agent, and/or an anti-angiogenic agent.

In one embodiment, the at least one additional therapeutically activeagent is an immunotherapeutic agent. In some embodiments, animmunotherapeutic agent is selected from the group consisting of:monoclonal antibody, an immune effector cell, adoptive cell transfer, animmunotoxin, a vaccine, or a cytokine.

In other embodiments, an immunotherapeutic agent is an agent that canmodulate the physiological levels of one or more cytokines in the tumormicroenvironment of cancers. In some embodiments, the immunotherapeuticagent induces local production of at least one endogenous cytokine thathas cytotoxic effect on tumor cells, such as TNF-α or IFN-γ. In someembodiments, the immunotherapeutic agent inhibits the production of anendogenous cytokine that interferes with T-cell recognition anddestruction of cancer cells, such as IL-10, TGFβ, or VEGF.

In other embodiments, an immunotherapeutic agent is an agent that caninduce tumor cell production of one or more chemokines that attractimmune cells such as dendritic cells, effector T-cell (e.g., CD8+lymphocytes), and natural killer (NK) cells to tumor cells. In someembodiments, the chemokines include, but are not limited to, CCL19,CCL20, CCL21, CX3CL1, CXCL9, and CXCL10.

In other embodiments, an immunotherapeutic agent is an agent thatinduces immune checkpoint blockade, such as PD-1 blockade and CTLA-4blockade.

In some embodiments, the immunotherapeutic agent is an antibody or anantigen-binding portion thereof that disrupts the interaction betweenProgrammed Death-1 (PD-1) and Programmed Death Ligand-1 (PD-L1). In oneembodiment, an immunotherapeutic agent is selected from the groupconsisting of: an anti-PD-1 antibody, a PD-1 antagonist, an anti-PD-L1antibody, a siRNA targeting expression of PD-1, a siRNA targeting theexpression of PD-L1, and a peptide, fragment, dominant negative form, orsoluble form of PD-1 or PD-L1.

In one embodiment, an immunotherapeutic agent is a monoclonal antibody.In one embodiment, the monoclonal antibody is selected from the groupconsisting of anti-PD-1 antibody, nivolumab, pembrolizumab alemtuzumab,bevacizumab, brentuxima b vedotin, cetuximab, gemtuzumab ozogamicin,ibritumomab tiuxetan, ipilimumab, ofatumumab, panitumumab, rituximab,tositumomab, trastuzumab, anti-B7-H4, anti-B7-H1, anti-LAG3, BTLA,anti-Tim3, anti-B7-DC, anti-CD160, MR antagonist antibodies, anti-4-1BB,anti-OX40, anti-CD27, and/or CD40 agonist antibodies. In someembodiments, an immunotherapeutic agent is an anti-PD-1 antibody. Inother embodiments, an anti-PD-1 antibody is a humanized antibody. In oneembodiment, the monoclonal antibody is selected from the groupconsisting of nivolumab and pembrolizumab. In a specific embodiment, themonoclonal antibody is nivolumab.

In one embodiment, an immunotherapeutic agent is selected from the groupconsisting of a CTLA-4 antagonist, an anti-CTLA-4 antibody, a siRNAtargeting the expression of CTLA-4, and/or a peptide, fragment, dominantnegative or soluble form of CTLA-4. In one embodiment, the anti-CTLA-4antibody is ipilimumab.

In some embodiments, the pharmaceutical combination is providedcomprising a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or salts, solvates,esters and/or prodrugs thereof and at least one anticancer agent. In oneembodiment, said anticancer agent is selected from the group consistingof an alkylating agent, an anti-metabolite, a vinca alkaloid, a taxane,a topoisomerase inhibitor, an anti-tumor antibiotic, a tyrosine kinaseinhibitor, an immunosuppressive macrolide, an Akt inhibitor, an HD ACinhibitor an Hsp90 inhibitor, an mTOR inhibitor, a PI3K/mTOR inhibitor,a PI3K inhibitor, a CDK (cyclin-dependent kinase) inhibitor, CHK(checkpoint kinase) inhibitor, PARP (poly (DP-ribose)polymerase)inhibitors, and combinations thereof.

In one embodiment, at least one anticancer agent is a PI3K inhibitor. Inanother embodiment, the PI3K inhibitor is Idelalisib.

In one embodiment, at least one anticancer agent is a PARP inhibitor. Inanother embodiment, the PARP inhibitor is Olaparib.

In other embodiments, the pharmaceutical combination is providedcomprising a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or salts, solvates,esters and/or prodrugs thereof and at least one anti-angiogenic agent.In one embodiment, said anti angiogenic agent is selected from the groupconsisting of 2-methoxyestradiol, AG3340, prinomastat, batimastat, BAY12-9566, carboxyamidotriazole, CC-1088, dextromethorphan acetic acid,dimethylxanthenone acetic acid, EMD 121974, endostatin, IM-862,marimastat, matrix metalloproteinase, penicillamine, PTK787/ZK 222584,RPI.4610, squalamine, squalamine lactate,3-[2,4-dimethylpyrrol-5-yl-methyl-idenyl]-2-indolinone (SU5416),(±)-thalidomide, S-thalidomide, R-thalidomide,O-(chloroacetylcarbamoyl)fumagillol (TNP-470), combretastatin,paclitaxel, tamoxifen, COL-3, neovastat, BMS-275291, SU6668, 2-ME,interferon-alpha, anti-VEGF antibody, Medi-522 (Vitaxin II), CAI(inhibitor of calcium influx), celecoxib, Interleukin-12, IM862,amilloride, Angiostatin® protein, angiostatin K1-3, angiostatin K1-5,captopril, DL-alpha-difluoromethylornithine,DL-alpha-difluoromethylomithine HCl, His-Tag® Endostatin™ Protein,fumagillin, herbimycin A, 4-hydroxyphenylretinamide, gamma-interferon,juglone, laminin, laminin hexapeptide, laminin pentapeptide, lavendustinA, medroxyprogesterone, medroxyprogesterone acetate, minocycline,minocycline HCl, placental ribonuclease inhibitor, suramin, sodium saltSuramin, human platelet thrombospondin, tissue inhibitor ofmetalloproteinase 1, neutrophil granulocyte tissue inhibitor ofmetalloproteinase 1, rheumatoid synovial fibroblast tissue inhibitor ofmetalloproteinase 2, and combinations thereof.

In some embodiments, a pharmaceutical combination is provided comprisinga compound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA),and/or their subgenera, or Compound A, or salts, solvates, esters and/orprodrugs thereof, at least one additional therapeutically active agent,and a pharmaceutically acceptable excipient or a pharmaceuticallyacceptable carrier.

In one embodiment, a pharmaceutical combination is provided comprising acompound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/ortheir subgenera, or Compound A, or salts, solvates, esters and/orprodrugs thereof, which is present in an amount from about 1 mg to about500 mg.

In another embodiment, the pharmaceutical combination is providedwherein the compound is compound A and wherein the at least oneadditional therapeutically active agent is selected from one or more ofthe group consisting of a PARP inhibitor and an anti-PD-1 antibody. In aspecific embodiment the PARP inhibitor is Olaparib. In another specificembodiment, the anti-PD-1 antibody is nivolumab.

In one embodiment, a method for stabilizing G-quadruplexes (G4s) in asubject is provided where the method comprises administering to thesubject a therapeutically effective amount of a pharmaceuticalcombination comprising a compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or salts,solvates, esters and/or prodrugs thereof and at least one additionaltherapeutically active agent, as described herein. In some embodiments,a method for stabilizing G-quadruplexes (G4s) in a subject is providedwhere the method comprises administering to the subject atherapeutically effective amount of a pharmaceutical combinationcomprising a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or salts, solvates,esters and/or prodrugs thereof and administering radiotherapy or atleast one additional therapeutically active agent before, during, orafter the subject has been administered the aforementioned compound.

In one embodiment, a method for modulating p53 activity in a subject isprovided where the method comprises administering to the subject atherapeutically effective amount of a pharmaceutical combinationcomprising a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or salts, solvates,esters and/or prodrugs thereof and at least one additionaltherapeutically active agent, as described herein. In some embodiments,a method for modulating p53 activity in a subject is provided where themethod comprises administering to the subject a therapeuticallyeffective amount of a pharmaceutical combination comprising a compoundof formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or salts, solvates, esters and/or prodrugsthereof and administering radiotherapy or at least one additionaltherapeutically active agent before, during, or after the subject hasbeen administered the aforementioned compound.

In one embodiment, a method for treating or ameliorating cellproliferation disorder in a subject is provided where said methodcomprises administering to a subject in need thereof a therapeuticallyeffective amount of a pharmaceutical combination comprising a compoundof formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or salts, solvates, esters and/or prodrugsthereof and at least one additional therapeutically active agent, asdescribed herein. In some embodiments, a method for treating orameliorating cell proliferation disorder in a subject is provided wheresaid method comprises administering to a subject in need thereof atherapeutically effective amount of a compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or salts, solvates, esters and/or prodrugs thereof and administeringradiotherapy or at least one additional therapeutically active agentbefore, during, or after the subject has been administered theaforementioned compound.

In one embodiment, the methods described herein provides administering atherapeutically effective amount of a pharmaceutical combinationcomprising a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or salts, solvates,esters and/or prodrugs thereof and at least one additionaltherapeutically active agent, where said at least one additionaltherapeutically active agent is selected from the group consisting ofimmunotherapeutic agents, anticancer agents, and angiogenic agents.

In one embodiment, the methods described herein are useful for thetreatment of cancer. In one embodiment, said cancer is selected from thegroup consisting of: heme cancer, colorectum cancer, ovarian cancer,breast cancer, cervical cancer, lung cancer, liver cancer, pancreaticcancer, cancer of the lymph nodes, colon cancer, prostate cancer, braincancer, cancer of the head and neck, bone cancer, Ewing's sarcoma, skincancer, kidney cancer, and cancer of the heart. In another embodiment,said cancer is selected from the group consisting of wherein the canceris selected from the group consisting of breast cancer, ovarian cancer,pancreatic cancer, prostate cancer, lung cancer, Ewing's sarcoma, headand neck cancer, and cervical cancer.

In one embodiment, the methods described herein are useful for treatmentof heme cancer. In some embodiments, said heme cancer is selected fromthe group consisting of: leukemia, lymphoma, myeloma, and multiplemyeloma.

In some embodiments, the methods described herein are useful fortreatment of cancer which is homologous recombination dependent doublestrand break repair deficient cancer. In another embodiment, the methodsdescribed herein are useful for treatment of cancer cells harboringdefects in breast cancer 1 (BRCA1), breast cancer 2 (BRCA2), and/orother members of the homologous recombination pathway. In oneembodiment, the cancer cells have phenotype selected from the groupconsisting of: an ataxia telangiectasia mutated (ATM) deficientphenotype, an ataxia telangiectasia and Rad3 related (ATR) deficientphenotype, an CHK1 checkpoint homolog (S. pombe) (CHK1) deficientphenotype, an CHK2 checkpoint homolog (S. pombe) (CHK2) deficientphenotype, an RAD51 homoiog (RecA homolog, E. coli) (S. cerevisiae)(Rad51) deficient phenotype, an replication protein A (RPA) deficientphenotype and an X-ray repair complementing defective repair in Chinesehamster cells 3 (XRCC3) deficient phenotype. In one embodiment, thecancer cells are deficient in a gene selected from the group consistingof: ATM, ATR, CHK1, CHK2, Rad51, RPA and XRCC3. In another embodiment,the cancer cells are deficient in a gene selected from the groupconsisting of: Fanconi anemia, complementation group A (FANCA), Fanconianemia, complementation group (FANCC), Fanconi anemia, complementationgroup D2 (FANCD2), Fanconi anemia, complementation group F (FANCF),Fanconi anemia, complementation group G (FANCG) and Fanconi anemia,complementation group M (FANCM). In another embodiment, the cancer cellsare homozygous for a mutation in a gene selected from the groupconsisting of: FANCA, FANCC, FANCD2, FANCF, FANCG and FANCM. In someembodiments, said cancer cells are deficient in BRCA1 and/or BRCA2. Inone embodiment, the cancer cells are homozygous for a mutation in BRCA1and/or BRCA2. In another embodiment, the cancer cells are heterozygousfor a mutation in BRCA1 and/or BRCA2.

In one embodiment, the methods described herein are useful for treatinga human subject.

In another embodiment, the methods described herein, further comprisesadministering one or more additional therapeutic agents. In oneembodiment, said one or more additional therapeutic agent is ananticancer agent.

In one embodiment, a method is provided for reducing or inhibiting cellproliferation where said method comprises contacting cells with atherapeutically effective amount of a pharmaceutical combinationcomprising a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or salts, solvates,esters and/or prodrugs thereof and at least one additionaltherapeutically active agent, as described herein. In some embodiments,a method is provided for reducing or inhibiting cell proliferation wheresaid method comprises contacting cells with a compound of formula (I),(IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or salts, solvates, esters and/or prodrugs thereof andadministering radiotherapy before, during, or after the cell has beencontacted with a compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A.

In one embodiment, the method for reducing or inhibiting cellproliferation as described herein are in a cancer cell line or in atumor in a subject. In one embodiment, said cancer cell line is a cancercell line selected from the group consisting of: heme cancer, colorectumcancer, ovarian cancer, breast cancer, cervical cancer, lung cancer,liver cancer, pancreatic cancer, cancer of the lymph nodes, coloncancer, prostate cancer, brain cancer, cancer of the head and neck, bonecancer, Ewing's sarcoma, skin cancer, kidney cancer, and cancer of theheart. In another embodiment, a cancer cell line selected from the groupconsisting of wherein the cancer is selected from the group consistingof breast cancer, ovarian cancer, pancreatic cancer, prostate cancer,lung cancer, Ewing's sarcoma, head and neck cancer, and cervical cancer.

In one embodiment, the method for reducing or inhibiting cellproliferation as described herein are in a cancer cell line or in atumor in a subject is a heme cancer cell line is selected from the groupconsisting of: leukemia, lymphoma, myeloma, and multiple myeloma.

In one embodiment, the method for reducing or inhibiting cellproliferation as described herein are in cancer cells harboring a defectin breast cancer 1 (BRCA1), breast cancer 2 (BRCA2), and/or othermembers of the homologous recombination pathway. In one embodiment, thecancer cells have phenotype selected from the group consisting of: anataxia telangiectasia mutated (ATM) deficient phenotype, an ataxiatelangiectasia and Rad3 related (ATR) deficient phenotype, an CHK1checkpoint homolog (S. pombe) (CHK1) deficient phenotype, an CHK2checkpoint homolog (S. pombe) (CHK2) deficient phenotype, an RAD51homolog (RecA homolog, E. coli) (S. cerevisiae) (Rad51) deficientphenotype, an replication protein A (RPA) deficient phenotype and anX-ray repair complementing defective repair in Chinese hamster cells 3(XRCC3) deficient phenotype. In one embodiment, the cancer cells aredeficient in a gene selected from the group consisting of: ATM, ATR,CHK1, CHK2, Rad51, RPA and XRCC3. In another embodiment, the cancercells are deficient in a gene selected from the group consisting of:Fanconi anemia, complementation group A (FANCA), Fanconi anemia,complementation group (FANCC), Fanconi anemia, complementation group D2(FANCD2), Fanconi anemia, complementation group F (FANCF), Fanconianemia, complementation group G (FANCG) and Fanconi anemia,complementation group M (FANCM). In another embodiment, the cancer cellsare homozygous for a mutation in a gene selected from the groupconsisting of: FANCA, FANCC, FANCD2, FANCF, FANCG and FANCM. In someembodiments, said cancer cells are deficient in BRCA1 and/or BRCA2. Inone embodiment, the cancer cells are homozygous for a mutation in BRCA1and/or BRCA2. In another embodiment, the cancer cells are heterozygousfor a mutation in BRCA1 and/or BRCA2.

In one embodiment, the methods described herein is useful inadministering said pharmaceutical combinations 1-4 times a day, 1-6times a week, 1-4 times a month, once a week, once every two weeks, onceevery three weeks, or once a month.

BRIEF DESCRIPTIONS OF THE FIGURES

FIGS. 1A-1D show growth inhibition and Loewe Excess in Compound A andOlaparib combination for 48 hours. FIG. 1A shows a dose matrix showinginhibition (%) for the combination in DLD1 parental cell lines. FIG. 1Bshows Loewe excess for the combination in FIG. 1A. FIG. 1C shows a dosematrix showing inhibition (%) for the combination in DLD1-BRCA2 (−/−)isogenic cell lines. FIG. 1D shows Loewe excess for the combination inFIG. 1C.

FIGS. 2A-2D show growth inhibition and Loewe Excess in Compound A andOlaparib combination for 144 hours. FIG. 2A shows a dose matrix showinginhibition (%) for the combination in DLD1 parental cell lines. FIG. 2Bshows Loewe excess for the combination in FIG. 2A. FIG. 2C shows a dosematrix showing inhibition (%) for the combination in DLD1-BRCA2 (−/−)isogenic cell lines. FIG. 2D shows Loewe excess for the combination inFIG. 2C.

FIGS. 3A-3C show combination therapy of Compound A and the PARPinhibitor Olaparib demonstrating in vivo synergy in a PDX model ofBRCA2-deficient TNBC. FIG. 3A shows treatments of Olaparib (50 mg, qd×7)and Olaparib (50 mg, qd×7) combined with Compound A (50 mg qwk×2). FIG.3B shows treatments of Olaparib (50 mg, qd×28) and Olaparib (50 mg,qd×28) combined with Compound A (50 mg qwk×2). FIG. 3C shows treatmentsof Olaparib (50 mg, qd×28) and Compound A (50 mg qwk×2) combined withOlaparib (50 mg, qd×7).

FIG. 4A shows dose response curves of TNF-α on BRCA positive (UWB 1.289)cell viability following treatment with various concentrations ofCompound A. FIG. 4B shows dose response curves of INF-γ on BRCA positivecell viability following treatment with various concentrations ofCompound A. % inhibition values of CellTiter-Glo® Luminescent cellviability assay.

FIG. 5A shows dose response curves of TNF-α on BRCA1 negative (UWB1.289-2945) cell viability following treatment with variousconcentrations of Compound A. FIG. 5B shows dose response curves ofINF-γ on BRCA1 negative cell viability following treatment with variousconcentrations of Compound A. % inhibition values of CellTiter-Glo®Luminescent cell viability assay. Each data point is mean±SD from threeindependent determinations.

FIG. 6A shows student t-test of viability of TNF-α on BRCA1 negative(UWB 1.289-2945) cell following treatment with various concentrations ofCompound A. FIG. 6B shows student t-test of viability of INF-γ on BRCA1negative cell following treatment with various concentrations ofCompound A. Each data point is mean±SD from three independentdeterminations. ** p<0.01, * p<0.05.

FIG. 7 shows in vitro induction of IFN-γ by nivolumab or isotype controlantibody (hlgG4 control). 10⁵ purified CD4⁺ T cells were cultured with10⁴ allogeneic monocyte-derived dendritic cells (DCs) in the presence ofa titration of nivolumab or isotype control antibody in triplicates for6 days. Supernatants were collected at day 5 and measured for IFN-γproduction by ELISA. Representative data from multiple donor DC/T-cellpairs are show. Left panel: induced IFN-γ concentration in the presenceof a titration of nivolumab or isotype control antibody. Right panel:IFN-γ concentration as measured by counts per minute (CPM).

FIG. 8A-8C show effects of Compound A treatment on chemokine expressionsin BRCA2 wild type (WT) and mutant (Mut) PDX-derived breast cancercells. FIG. 8A shows fold changes of CCL19 in both WT (left panel) andMut (right panel) in cancer cells with the treatment of a titration ofCompound A at day 14 and day 28. FIG. 8B shows fold changes of CCL21 inboth WT (left panel) and Mut (right panel) in cancer cells with thetreatment of a titration of Compound A at day 14 and day 28. FIG. 8Cshows fold changes of CXCL9 in both WT (left panel) and Mut (rightpanel) in cancer cells with the treatment of a titration of Compound Aat day 14 and day 28.

FIG. 9 shows hypothetical mechanisms by which a pharmaceuticalcombination comprising a compound of the present invention, such asCompound A, and an immunotherapeutic agent, such as an agent that caninduce the production of endogenous cytotoxic cytokines (e.g., TNF-α andIFN-γ), such as an anti-PD-1 antibody, in treating cancer. Thecombination may exert potent antitumor effects through increasedimmunogenicity of cancer cells. Compound A incudes production ofchemokines such as CCL19, CCL20, CCL21, CXCL9, CXCL10, and CXCL12 intumor cells. These chemokines in turn attract active immune cells suchas DC, NK, and TCD8. These immune cells release cytotoxic compounds suchas cytokines TNF-α and IFN-γ. Compound A thus enhances the cytotoxicityof TNF-α and IFN-γ which leads to tumor cells death. DC: dendritic cell;NL: natural killer cell; TCD8: CD8⁺ T-cell.

DETAILED DESCRIPTIONS OF THE DISCLOSURE

In patients with disorders related to proliferation of cells, such ascancers, activation of p53 protein may inhibit, alter, or reduce cellproliferation and/or induce cell apoptosis. Accordingly, by providingpatients suffering from such disorders with a pharmaceutically activePol I inhibitor that selectively activates p53 protein of the cancerand/or tumor cells can be alleviate or prevent the disorders or theprogression of the disorders. The present invention provides methods,combinations, and compositions for treating a cancer or tumor whichcomprise the use of Compound A, or a pharmaceutically acceptable salt,ester, solvate, and/or prodrug thereof in combination with at least oneadditional therapeutically active agents or a therapy. In oneembodiment, the present disclosure provides a combination therapy forthe use of Compound A and another therapy, such as radiotherapy. Inanother embodiment, The present invention relates to combination therapyfor Compound A and at least one additional therapeutically activeagents, including immunotherapeutics, targeted therapeutics (includingkinase inhibitors), and anti-angiogenics.

Definitions

It is to be understood that the terminology used herein is for thepurpose of describing particular embodiments only and is not intended tobe limiting.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood to one of ordinary skill inthe art to which the present application belongs. Although any methodsand materials similar or equivalent to those described herein can beused in the practice or testing of the present application,representative methods and materials are herein described.

Following long-standing patent law convention, the terms “a”, “an”, and“the” refer to “one or more” when used in this application, includingthe claims. Thus, for example, reference to “a carrier” includesmixtures of one or more carriers, two or more carriers, and the like.

Unless otherwise indicated, all numbers expressing quantities ofingredients, reaction conditions, and so forth used in the specificationand claims are to be understood as being modified in all instances bythe term “about”. Accordingly, unless indicated to the contrary, thenumerical parameters set forth in the present specification and attachedclaims are approximations that can vary depending upon the desiredproperties sought to be obtained by the present application. Generallythe term “about”, as used herein when referring to a measurable valuesuch as an amount of weight, time, dose, etc. is meant to encompass inone example variations of ±15% or ±10%, in another example ±5%, inanother example ±1%, and in yet another example ±0.1% from the specifiedamount, as such variations are appropriate to perform the disclosedmethod.

The term “compound(s) of the present invention” or “present compound(s)”refers compounds of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA),and/or their subgenera, or2-(4-Methyl-[1,4]diazepan-1-yl)-5-oxo-5H-7-thia-1,11b-diaza-benzo[c]fluorene-6-carboxylicacid (5-methyl-pyrazin-2-ylmethyl)-amide (Compound A) or isomers,N-oxides, salts, esters, solvates, prodrugs thereof. Alternatively theabove terms may refer to salt form of compounds of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or solvate thereof. Compounds of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A describedthroughout the application may include any single isomer or a mixture ofany number of isomers.

The term “isomer” refers to compounds having the same chemical formulabut may have different stereochemical formula, structural formula, orspecial arrangements of atoms. Examples of isomers includestereoisomers, diastereomers, enantiomers, conformational isomers,rotamers, geometric isomers, and atropisomers.

The term “N-oxide”, also known as amine oxide or amine-N-oxide, means acompound that derives from a compound of the present invention viaoxidation of an amine group of the compound of the present invention. AnN-oxide typically contains the functional group R₃N⁺—O⁻ (sometimeswritten as R₃N═O or R₃N→O).

The term “ester” refers to any ester of a compound of the presentinvention in which any of the —COOH functions of the molecule isreplaced by a —COOR function, in which the R moiety of the ester is anycarbon-containing group which forms a stable ester moiety, including butnot limited to alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkylalkyl,aryl, arylalkyl, heterocyclyl, heterocyclylalkyl and substitutedderivatives thereof. The term “ester” includes but is not limited topharmaceutically acceptable esters thereof. Pharmaceutically acceptableesters include, but are not limited to, alkyl, alkenyl, alkynyl, aryl,heteroaryl, aralkyl, heteroaralkyl, cycloalkyl and heterocyclyl estersof acidic groups, including, but not limited to, carboxylic acids,phosphoric acids, phosphinic acids, sulfonic acids, sulfinic acids andboronic acids.

The term “composition” or “formulation” denotes one or more substance ina physical form, such as solid, liquid, gas, or a mixture thereof. Oneexample of composition is a pharmaceutical composition, i.e., acomposition related to, prepared for, or used in medical treatment.

The term “carboxylic acid” refers to an organic acid characterized byone or more carboxyl groups, such as acetic acid and oxalic acid.“Sulfonic acid” refers to an organic acid with the general formula ofR—(S(O)₂—OH)_(n), wherein R is an organic moiety and n is an integerabove zero, such as 1, 2, and 3. The term “polyhydroxy acid” refers to acarboxylic acid containing two or more hydroxyl groups. Examples ofpolyhydroxy acid include, but are not limited to, lactobionic acid,gluconic acid, and galactose.

As used herein, “pharmaceutically acceptable” means suitable for use incontact with the tissues of humans and animals without undue toxicity,irritation, allergic response, and the like, commensurate with areasonable benefit/risk ratio, and effective for their intended usewithin the scope of sound medical judgment.

“Salts” include derivatives of an active agent, wherein the active agentis modified by making acid or base addition salts thereof. Preferably,the salts are pharmaceutically acceptable salts. Such salts include, butare not limited to, pharmaceutically acceptable acid addition salts,pharmaceutically acceptable base addition salts, pharmaceuticallyacceptable metal salts, ammonium and alkylated ammonium salts. Acidaddition salts include salts of inorganic acids as well as organicacids. Representative examples of suitable inorganic acids includehydrochloric, hydrobromic, hydroiodic, phosphoric, sulfuric, nitricacids and the like. Representative examples of suitable organic acidsinclude formic, acetic, trichloroacetic, trifluoroacetic, propionic,benzoic, cinnamic, citric, fumaric, glycolic, lactic, maleic, malic,malonic, mandelic, oxalic, picric, pyruvic, salicylic, succinic,methanesulfonic, ethanesulfonic, tartaric, ascorbic, pamoic,bismethylene salicylic, ethanedisulfonic, gluconic, citraconic,aspartic, stearic, palmitic, EDTA, glycolic, p-aminobenzoic, glutamic,benzenesulfonic, p-toluenesulfonic acids, sulphates, nitrates,phosphates, perchlorates, borates, acetates, benzoates,hydroxynaphthoates, glycerophosphates, ketoglutarates and the like. Baseaddition salts include but are not limited to, ethylenediamine,N-methyl-glucamine, lysine, arginine, ornithine, choline,N,N′-dibenzylethylenediamine, chloroprocaine, diethanolamine, procaine,N-benzylphenethylamine, diethylamine, piperazine,tris-(hydroxymethyl)-aminomethane, tetramethylammonium hydroxide,triethylamine, dibenzylamine, ephenamine, dehydroabietylamine,N-ethylpiperidine, benzylamine, tetramethylammonium, tetraethylammonium,methylamine, dimethylamine, trimethylamine, ethylamine, basic aminoacids, e. g., lysine and arginine dicyclohexylamine and the like.Examples of metal salts include lithium, sodium, potassium, magnesiumsalts and the like. Examples of ammonium and alkylated ammonium saltsinclude ammonium, methylammonium, dimethylammonium, trimethylammonium,ethylammonium, hydroxyethylammonium, diethylammonium, butylammonium,tetramethylammonium salts and the like. Examples of organic basesinclude lysine, arginine, guanidine, diethanolamine, choline and thelike. Standard methods for the preparation of pharmaceuticallyacceptable salts and their formulations are well known in the art, andare disclosed in various references, including for example, “Remington:The Science and Practice of Pharmacy”, A. Gennaro, ed., 20th edition,Lippincott, Williams & Wilkins, Philadelphia, Pa.

As used herein, “solvate” means a complex formed by solvation (thecombination of solvent molecules with molecules or ions of the activeagent of the present invention), or an aggregate that consists of asolute ion or molecule (the active agent of the present invention) withone or more solvent molecules. In the present invention, the preferredsolvate is hydrate. Examples of hydrate include, but are not limited to,hemihydrate, monohydrate, dihydrate, trihydrate, hexahydrate, etc. Itshould be understood by one of ordinary skill in the art that thepharmaceutically acceptable salt of the present compound may also existin a solvate form. The solvate is typically formed via hydration whichis either part of the preparation of the present compound or throughnatural absorption of moisture by the anhydrous compound of the presentinvention. Solvates including hydrates may be consisting instoichiometric ratios, for example, with two, three, four salt moleculesper solvate or per hydrate molecule. Another possibility, for example,that two salt molecules are stoichiometric related to three, five, sevensolvent or hydrate molecules. Solvents used for crystallization, such asalcohols, especially methanol and ethanol; aldehydes; ketones,especially acetone; esters, e.g. ethyl acetate; may be embedded in thecrystal grating. Preferred are pharmaceutically acceptable solvents.

The terms “excipient”, “carrier”, and “vehicle” are usedinterexchangeably throughout this application and denote a substancewith which a compound of the present invention is administered.

“Therapeutically effective amount” means the amount of a compound or atherapeutically active agent that, when administered to a patient fortreating a disease or other undesirable medical condition, is sufficientto have a beneficial effect with respect to that disease or condition.The therapeutically effective amount will vary depending on the type ofthe selected compound or a therapeutically active agent, the disease orcondition and its severity, and the age, weight, etc. of the patient tobe treated. Determining the therapeutically effective amount of a givencompound or a therapeutically active agent is within the ordinary skillof the art and requires no more than routine experimentation.

The term “combination therapy” refers to a first therapy that includes acompound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/ortheir subgenera, or Compound A in conjunction with a second therapy(e.g., therapy, surgery and/or an additional pharmaceutical agent)useful for treating, stabilizing, preventing, and/or delaying thedisease or condition. Administration in “conjunction with” anothertherapeutically active agent includes administration in the same ordifferent composition(s) and/or combinations, either sequentially,simultaneously, or continuously, through the same or different routes.In some embodiments, the combination therapy optionally includes one ormore pharmaceutically acceptable carriers or excipients,non-pharmaceutically active compounds, and/or inert substances.

The terms “pharmaceutical combination,” “therapeutic combination” or“combination” as used herein, refers to a single dosage form comprisingat least two therapeutically active agents, or separate dosage formscomprising at least two therapeutically active agents together orseparately for use in combination therapy. For example, onetherapeutically active agent may be formulated into one dosage form andthe other therapeutically active agent may be formulated into a singleor different dosage forms. For example, one therapeutically active agentmay be formulated into a solid oral dosage form whereas the secondtherapeutically active agent may be formulated into a solution dosageform for parenteral administration.

As used herein, the terms “additional pharmaceutical agent” or“additional therapeutic agent” or “additional therapeutically activeagent” with respect to the compounds described herein refers to anactive agent other than the compounds of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, which isadministered to elicit a therapeutic effect. The pharmaceutical agent(s)may be directed to a therapeutic effect related to the condition thatthe compounds of the present disclosure is intended to treat or prevent(e.g., cancer) or, the pharmaceutical agent may be intended to treat orprevent a symptom of the underlying condition (e.g., tumor growth,hemorrhage, ulceration, pain, enlarged lymph nodes, cough, jaundice,swelling, weight loss, cachexia, sweating, anemia, paraneoplasticphenomena, thrombosis, etc.) or to further reduce the appearance orseverity of side effects of the compounds of the present disclosure.

The term “immunotherapeutics” refers to chemicals and biologics whichmodulates a person's immune response to impart desirable therapeuticeffect.

The term “anticancer agents” refers to chemicals and biologics which maytreat, reduce, prevent, or ameliorate conditions cause by cancer ortumor growth.

The term “anti-angiogenics” or “angiogenesis inhibitors” refers tochemicals that blocks formation of new blood vessels by tumor and cancercells (angiogenesis).

The term “radiotherapy” or “radiation therapy” refers to treatment ofcancer or tumors through the use of beam of ionizing radiation, as iswell known in the art.

As used herein, the phrase “a disorder characterized by cellproliferation” or “a condition characterized by cell proliferation”include, but are not limited to, cancer, benign and malignant tumors.Examples of cancer and tumors include, but are not limited to, cancersor tumor growth of the colorectum, breast, lung, liver, pancreas, lymphnode, colon, prostate, brain, head and neck, skin, kidney, blood andheart (e.g., leukemia, lymphoma, carcinoma).

The terms “treat”, “treating” or “treatment” in reference to aparticular disease or disorder includes prevention of the disease ordisorder, and/or lessening, improving, ameliorating or abrogating thesymptoms and/or pathology of the disease or disorder. Generally theterms as used herein refer to ameliorating, alleviating, lessening, andremoving symptoms of a disease or condition. A candidate molecule orcompound described herein may be in a therapeutically effective amountin a formulation or medicament, which is an amount that can lead to abiological effect, such as apoptosis of certain cells (e.g., cancercells), reduction of proliferation of certain cells, or lead toameliorating, alleviating, lessening, or removing symptoms of a diseaseor condition, for example. The terms also can refer to reducing orstopping a cell proliferation rate (e.g., slowing or halting tumorgrowth) or reducing the number of proliferating cancer cells (e.g.,removing part or all of a tumor). These terms also are applicable toreducing a titre of a microorganism in a system (i.e., cell, tissue, orsubject) infected with a microorganism, reducing the rate of microbialpropagation, reducing the number of symptoms or an effect of a symptomassociated with the microbial infection, and/or removing detectableamounts of the microbe from the system. Examples of microorganisminclude but are not limited to virus, bacterium and fungus.

As used herein, the terms “inhibiting” or “reducing” cell proliferationis meant to slow down, to decrease, or, for example, to stop the amountof cell proliferation, as measured using methods known to those ofordinary skill in the art, by, for example, 10%, 20%, 30%, 40%, 50%,60%, 70%, 80%, 90%, 95%, or 100%, when compared to proliferating cellsthat are not subjected to the methods, compositions, and combinations ofthe present application.

As used herein, the term “apoptosis” refers to an intrinsic cellself-destruction or suicide program. In response to a triggeringstimulus, cells undergo a cascade of events including cell shrinkage,blebbing of cell membranes and chromatic condensation and fragmentation.These events culminate in cell conversion to clusters of membrane-boundparticles (apoptotic bodies), which are thereafter engulfed bymacrophages.

The term “patient” or “subject” as used herein, includes humans andanimals, preferably mammals.

Compounds

The present invention provides quinolone compounds of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or salts, solvates, esters and/or prodrugs thereof. The compoundsdisclosed herein can be used in a combination with at least oneadditional therapeutically agents or therapy (combination therapy).

In one embodiment, the invention includes a compound of formula (IA),

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

X¹ is CH or N;

X², X³, X⁴, X⁵, X⁶ and X⁷ independently are NR⁴, CH₂, CHQ or C(Q)₂,provided that: (i) zero, one or two of X², X³, X⁴, X⁵, X⁶ and X⁷ areNR⁴; (ii) when X¹ is N, both of X² and X⁷ are not NR⁴; (iii) when X¹ isN, X³ and X⁶ are not NR⁴; and (iv) when X¹ is CH and two of X², X³, X⁴,X⁵, X⁶ and X⁷ are NR⁴, the two NR⁴ are located at adjacent ringpositions or are separated by two or more other ring positions;

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², —R³, —W, -L-W, —W⁰, or -L-N(R)—W⁰;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR³R², —SR²,—OR², —R³, W, -L-W, —W⁰, or -L-N(R)—W⁰;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing one additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl; or R⁴ may be —W, -L-W or-L-N(R)—W⁰;

each R is independently H or C1-C6 alkyl;

R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, orC2-C10 heteroalkenyl, each of which may be optionally substituted withone or more halogens, ═O, or an optionally substituted 3-7 memberedcarbocyclic or heterocyclic ring; or in —NR⁷R⁸, R⁷ and R⁸ together withN may form an optionally substituted azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember;

m is 0, 1, 2, 3 or 4;

n is 0, 1, 2, 3, 4, or 5;

L is a C1-C10 alkylene, C1-C10 heteroalkylene, C2-C10 alkenylene orC2-C10 heteroalkenylene linker, each of which may be optionallysubstituted with one or more substituents selected from the groupconsisting of halogen, oxo (═O), or C1-C6 alkyl;

W is an optionally substituted 4-7 membered azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember; and

W⁰ is an optionally substituted 3-4 membered carbocyclic ring, or aC1-C6 alkyl group substituted with from 1 to 4 fluorine atoms.

In some embodiments of these compounds, X¹ is CH and two of X², X³, X⁴,X⁵, X⁶ and X⁷ are NR⁴. In some embodiments, X¹ is CH and one of X², X³,X⁴, X⁵, X⁶ and X⁷ are NR⁴. In other embodiments, X¹ is CH and none ofX², X³, X⁴, X⁵, X⁶ and X⁷ are NR⁴. In yet other embodiments, X¹ is N andnone of X², X³, X⁴, X⁵, X⁶ and X⁷ are NR⁴. In still other embodiments,X¹ is N and one of X⁴ or X⁵ is NR⁴.

In one embodiment, the invention provides a compound of formula (IB),

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

X¹ is CH or N;

X², X³, X⁴, X⁵, X⁶ and X⁷ independently are NR⁴, CH₂, CHQ or C(Q)₂,provided that zero, one or two of X², X³, X⁴, X⁵, X⁶ and X⁷ are NR⁴;

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR⁴R²,—SR², —OR², —R³, —W, -L-W, —W⁰, or -L-N(R)—W⁰;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR⁴R², —SR²,—OR², —R³, W, -L-W, —W⁰, or -L-N(R)—W⁰;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing one additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl; or R⁴ may be —W, -L-W or-L-N(R)—W⁰;

each R is independently H or C1-C6 alkyl;

R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, orC2-C10 heteroalkenyl, each of which may be optionally substituted withone or more halogens, ═O, or an optionally substituted 3-7 memberedcarbocyclic or heterocyclic ring; or in —NR⁷R⁸, R⁷ and R⁸ together withN may form an optionally substituted azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember;

m is 0, 1, 2, 3 or 4;

n is 0, 1, 2, 3, 4, or 5;

L is a C1-C10 alkylene, C1-C10 heteroalkylene, C2-C10 alkenylene orC2-C10 heteroalkenylene linker, each of which may be optionallysubstituted with one or more substituents selected from the groupconsisting of halogen, oxo (═O), or C1-C6 alkyl;

W is an optionally substituted 4-7 membered azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember; and

W⁰ is an optionally substituted 3-4 membered carbocyclic ring, or aC1-C6 alkyl group substituted with from 1 to 4 fluorine atoms.

In one embodiment, the invention provides a compound of formula (I),

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

X¹ is CH or N;

X², X³, X⁴, X⁵, X⁶ and X⁷ independently are NR⁴, CH₂, CHQ or C(Q)₂,provided that zero, one or two of X², X³, X⁴, X⁵, X⁶ and X⁷ are NR⁴;

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², or —R³;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR³R², —SR²,—OR², or —R³;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing one additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl;

R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, orC2-C10 heteroalkenyl, each of which may be optionally substituted withone or more halogens, ═O, or an optionally substituted 3-7 memberedcarbocyclic or heterocyclic ring; or in —NR⁷R⁸, R⁷ and R⁸ together withN may form an optionally substituted azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember;

m is 0, 1, 2, 3 or 4; and

n is 0, 1, 2, 3, 4, or 5.

In one embodiment, the invention provides a compound of formula (IIA),

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², —R³, —W, -L-W, —W⁰, or -L-N(R)—W⁰;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R², —SR²,—OR², —R³, W, -L-W, —W⁰, or -L-N(R)—W⁰;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing an additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl; or R⁴ may be —W, -L-W or-L-N(R)—W⁰;

each R is independently H or C1-C6 alkyl;

m is 0, 1, 2, 3 or 4;

n is 0, 1, 2, 3, 4 or 5;

p is 0, 1, 2 or 3;

L is a C1-C10 alkylene, C1-C10 heteroalkylene, C2-C10 alkenylene orC2-C10 heteroalkenylene linker, each of which may be optionallysubstituted with one or more substituents selected from the groupconsisting of halogen, oxo (═O), or C1-C6 alkyl;

W is an optionally substituted 4-7 membered azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember; and

W⁰ is an optionally substituted 3-4 membered carbocyclic ring, or aC1-C6 alkyl group substituted with from 1 to 4 fluorine atoms.

In one embodiment, the invention provides a compound of formula (II),

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², or —R³;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R², —SR²,—OR², or —R³;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing an additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl;

m is 0, 1, 2, 3 or 4;

n is 0, 1, 2, 3, 4 or 5; and

p is 0, 1, 2 or 3.

In another embodiment, the invention provides a compound of formula(IIIA),

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², —R³, —W, -L-W, —W⁰, or -L-N(R)—W⁰;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R², —SR²,—OR², —R³, W, -L-W, —W⁰, or -L-N(R)—W⁰;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing an additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl; or R⁴ may be —W, -L-W or-L-N(R)—W⁰;

each R is independently H or C1-C6 alkyl;

R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, orC2-C10 heteroalkenyl, each of which may be optionally substituted withone or more halogens, ═O, or an optionally substituted 3-7 memberedcarbocyclic or heterocyclic ring; or in —NR⁷R⁸, R⁷ and R⁸ together withN may form an optionally substituted azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember;

m is 0, 1, 2, 3 or 4;

n is 0, 1, 2, 3, 4 or 5;

L is a C1-C10 alkylene, C1-C10 heteroalkylene, C2-C10 alkenylene orC2-C10 heteroalkenylene linker, each of which may be optionallysubstituted with one or more substituents selected from the groupconsisting of halogen, oxo (═O), or C1-C6 alkyl;

W is an optionally substituted 4-7 membered azacyclic ring, optionallycontaining an additional heteroatom selected from N, O and S as a ringmember; and

W⁰ is an optionally substituted 3-4 membered carbocyclic ring, or aC1-C6 alkyl group substituted with from 1 to 4 fluorine atoms.

In another embodiment, the invention provides a compound of formula(III),

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof;

wherein:

A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R²,—SR², —OR², or —R³;

each Q is independently halo, azido, —CN, —CF₃, —CONR¹R², —NR¹R², —SR²,—OR², or —R³;

in each —NR¹R², R¹ and R² together with N may form an optionallysubstituted azacyclic ring, optionally containing an additionalheteroatom selected from N, O and S as a ring member;

R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O;

R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10heteroalkenyl, each of which may be optionally substituted with one ormore halogens, ═O, or an optionally substituted 3-7 membered carbocyclicor heterocyclic ring;

R³ is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10aryl, or C6-C12 arylalkyl, or a heteroform of one of these, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;

each R⁴ is independently H, or C1-C6 alkyl;

R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, orC2-C10 heteroalkenyl, each of which may be optionally substituted withone or more halogens, ═O, or an optionally substituted 3-7 memberedcarbocyclic or heterocyclic ring;

m is 0, 1, 2, 3 or 4; and

n is 0, 1, 2, 3, 4 or 5.

In one embodiment, the disclosure provides2-(4-Methyl-[1,4]diazepan-1-yl)-5-oxo-5H-7-thia-1,11b-diaza-benzo[c]fluorene-6-carboxylicacid (5-methyl-pyrazin-2-ylmethyl)-amide (Compound A) as shown below.

In another embodiment, the present invention provides a salt and/orsolvate of Compound A.

Additional Therapeutically Active Agents

In one embodiment, the present invention provides a combination therapycomprising a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A with at least oneadditional therapeutically agents or therapy. The followingtherapeutics, therapeutically active agents, and therapy may be employedin conjunction with the administration of the compounds described above.

Immunotherapeutics

Immunotherapy refers to a treatment of a subject afflicted with, or atrisk of contracting or suffering a recurrence of, a disease by a methodcomprising inducing, enhancing, suppressing or otherwise modifying animmune response. In one embodiment, an immunotherapeutic disrupts,reduces or suppresses signaling from an inhibitory immunoregulator. Mostimmunotherapeutic approaches on their own are of limited value againstmajority of cancers. Reasons for this include immune regulation mediatedby cancer cells and leukocyte populations through a variety ofcell-expressed and secreted molecules. For example, antitumor immunitywithin tumor microenvironment is suppressed by a variety of tumorinfiltrating leukocytes, including regulatory T cells (Treg),myeloid-derived suppressor cells (MDSC) and alternatively activated(type 2) macrophages (M2). Mechanisms employed by these cell types tosuppress effective immunity include secretion of cytokines such as IL-10and TGFβ, and expression of inhibitory receptors such as CTLA-4 andPD-L1. Tumor cells can actively inhibit immunotherapy through a numberof mechanisms, such as secretion of cytokines (e.g., VEGF and TGFβ) thatactively inhibit T cell recognition and destruction of tumor cells, orproduction of the ligand of Programmed Cell Death-1 (PD-L1) whichinhibits the function of PD-1 expressed on activated T cells, see(Devaud et al., Oncolmmunology 2:8 e25961, 2013).

The present invention provides pharmaceutical combinations comprising achemical compound described herein, such as Compound A, and at least oneimmunotherapeutic agent. The combinations are useful in treating orameliorating cell proliferation disorders, such as cancers. In someembodiments, the combinations provide synergistic therapeutic effectcompared to the chemical compound alone or the immunotherapeutic agentalone.

Without wishing to be bound by any particular theory, suchpharmaceutical combinations are effective in treating or amelioratingcell proliferation disorders through one or more of the mechanismsdescribed herein. In some embodiments, an immunotherapeutic agent of thepresent invention increases the local production of one or morecytokines that have cytotoxic effect on tumor cells. Such cytokinesinclude, but are not limited to Tumor necrosis factor α (TNFα) andInterferon gamma (IFNγ). A chemical compound described herein, such asCompound A, can enhance the cytotoxic effect of TNF-α and/or IFN-γ, thusthe combination can achieve greater therapeutic effect. In someembodiments, the chemical compound described herein, such as Compound A,can induce the production of chemokines in tumor cells, such as tumorcells with homologous recombination deficiency (e.g., tumor cells havingBRCA1 and/or BRCA2 mutation). The produced chemokines in turn attractimmune cells, dendritic cells (DCs), activated effector T-cells (e.g.,CD8+ lymphocytes), and/or natural killer (NK) cells to tumor cells, anddestruct the tumor cells. In some embodiments, the induced chemokinesare CCL19, CCL20, and/or CCL21 that attract dendritic cells. In someembodiments, the induced chemokine is CX3CL1 that attracts activatedeffector T-cells (e.g., CD8+ lymphocytes). In some embodiments, theinduced chemokines are CXCL9 and/or CXCL10 that attract activatedeffector T-cells (e.g., CD8+ lymphocytes) and NK cells.

In one embodiment, the immunotherapeutic agent is a monoclonal antibody,an immune effector cell, adoptive cell transfer, an immunotoxin, avaccine, and/or a cytokine.

In one embodiment, the immunotherapeutic agent is an agent that canmodulate the physiological levels of one or more cytokines in the tumormicroenvironment of cancers. In one embodiment, the cytokine modulatedby the immunotherapeutic is selected from one or more of the groupconsisting of TNF-α, IFN-γ, IL-10, TGFβ, and VEGF. In some embodiments,the immunotherapeutic agent induces production of an endogenous cytokinethat has cytotoxic effect on tumor cells, such as TNF-α or IFN-γ. Insome embodiments, the immunotherapeutic agent inhibits the production ofan endogenous cytokine that interferes with T-cell recognition anddestruction of cancer cells, such as IL-10, TGFβ, or VEGF.

In other embodiments, an immunotherapeutic agent is an agent that caninduce tumor cell production of one or more chemokines that attractimmune cells such as dendritic cells, effector T-cell (e.g., CD8+lymphocytes), and/or natural killer (NK) cells to tumor cells. In someembodiments, the chemokines include, but are not limited to, CCL19,CCL20, CCL21, CX3CL1, CXCL9, and CXCL10.

In other embodiments, the immunotherapeutic agent is an agent thatinduces immune checkpoint blockade, such as PD-1 blockade and CTLA-4blockade.

In some embodiments an immunotherapeutics is an antibody or anantigen-binding portion thereof that disrupts the interaction betweenPD-1 and PD-L1. In some embodiments, an immunotherapeutic agent isanti-PD-1 antibody, a PD-1 antagonist, an anti-PD-L1 antibody, a siRNAtargeting expression of PD-1, a siRNA targeting the expression of PD-L1,or a peptide, fragment, dominant negative form, or soluble form of PD-1or PD-L1. In one embodiment, an anti-PD-1 antibody is a monoclonalantibody and/or a humanized antibody. Cytotoxic T-lymphocyte antigen 4(CTLA4, also known as CD152) is a member of the immunoglobulinsuperfamily that is expressed exclusively on T-cells. CTLA4 acts toinhibit T-cell activation and is reported to inhibit helper T-cellactivity and enhance regulatory T-cell immunosuppressive activity. Insome embodiments, an immunotherapeutic is an antibody that disruptsCTLA4. In other embodiments, an immunotherapeutic agent is a CTLA-4antagonist, anti-CLTA-4 antibody, a siRNA targeting the expression ofCTLA-4, or a peptide, fragment, dominant negative form, or soluble formof CTLA-4. Other immunoglobulin superfamily members include, but are notlimited to, CD28, ICOS and BTLA.

In some embodiments, an immunotherapeutic agent is selected from thegroup consisting of anti-PD-1 antibody, nivolumab (BMS-936558,ONO-4538), lambrolizumab (MK-3475), pidilizumab (CT-011), alemtuzumab,bevacizumab, brentuximab vedotin, cetuximab, gemtuzumab ozogamicin,ibritumomab tiuxetan, ipilimumab, ofatumumab, panitumumab, rituximab,tositumomab, trastuzumab, tremelimumab, lirlumab, trevilizumab,AB134090, 11159-H03H, 11159-H08H, PA5-29572, PA5-23967, PA5-26465,MAI-12205, MAI-35914, AMP-224, MDX-1105, MEDI4736, MPDL3280A,BMS-936559, MIH1, anti-B7-H4, anti-B7-H1, anti-LAG3, BTLA, anti-Tim3,anti-B7-DC, anti-CD160, MR antagonist antibodies, anti-4-1BB, anti-OX40,anti-CD27, CD40 agonist antibodies, clone UC10-4F10-11, clone RPM1-14,clone 9D9, clone 10F.9G2, and the like, and mixtures thereof.

In one embodiment, an immunotherapeutic agent is an anti-PD-1 antibody.In another embodiment, an immunotherapeutic agent is nivolumab orpembrolizumab. In other embodiments, an immunotherapeutic agent is ananti-CTLA-4 antibody. In one embodiment, n immunotherapeutic agent isipilimumab.

Anticancer Agents

Anticancer agents used in combination with the compounds of the presentapplication may include agents selected from any of the classes known tothose of ordinary skill in the art, including, for example, alkylatingagents, anti-metabolites, plant alkaloids and terpenoids (e.g.,taxanes), topoisomerase inhibitors, anti-tumor antibiotics, kinaseinhibitors, hormonal therapies, molecular targeted agents, and the like.Generally such an anticancer agent is an alkylating agent, ananti-metabolite, a vinca alkaloid, a taxane, a topoisomerase inhibitor,an anti-tumor antibiotic, a tyrosine kinase inhibitor, animmunosuppressive macrolide, an Akt inhibitor, an HD AC inhibitor anHsp90 inhibitor, an mTOR inhibitor, a PI3K/mTOR inhibitor, a PI3Kinhibitor, a CDK (cyclin-dependent kinase) inhibitor, CHK (checkpointkinase) inhibitor, PARP (poly (DP-ribose)polymerase) inhibitors, and thelike.

Alkylating agents include (a) alkylating-like platinum-basedchemotherapeutic agents such as cisplatin, carboplatin, nedaplatin,oxaliplatin, satraplatin, and(SP-4-3)-(cis)-amminedichloro-[2-methylpyridine] platinum(II); (b) alkylsulfonates such as busulfan; (c) ethyleneimine and methylmelaminederivatives such as altretamine and thiotepa; (d) nitrogen mustards suchas chlorambucil, cyclophosphamide, estramustine, ifosfamide,mechlorethamine, trofosamide, prednimustine, melphalan, and uramustine;(e) nitrosoureas such as carmustine, lomustine, fotemustine, nimustine,ranimustine and streptozocin; (f) triazenes and imidazotetrazines suchas dacarbazine, procarbazine, temozolamide, and temozolomide.

Anti-metabolites include (a) purine analogs such as fludarabine,cladribine, chlorodeoxyadenosine, clofarabine, mercaptopurine,pentostatin, and thioguanine; (b) pyrimidine analogs such asfluorouracil, gemcitabine, capecitabine, cytarabine, azacitidine,edatrexate, floxuridine, and troxacitabine; (c) antifolates, such asmethotrexate, pemetrexed, raltitrexed, and trimetrexate.Anti-metabolites also include thymidylate synthase inhibitors, such asfluorouracil, raltitrexed, capecitabine, floxuridine and pemetrexed; andribonucleotide reductase inhibitors such as claribine, clofarabine andfludarabine.

Plant alkaloid and terpenoid derived agents include mitotic inhibitorssuch as the vinca alkaloids vinblastine, vincristine, vindesine, andvinorelbine; and microtubule polymer stabilizers such as the taxanes,including, but not limited to paclitaxel, docetaxel, larotaxel,ortataxel, and tesetaxel.

Topoisomerase inhibitors include topoisomerase I inhibitors such ascamptothecin, topotecan, irinotecan, rubitecan, and belotecan; andtopoisomerase II inhibitors such as etoposide, teniposide, andamsacrine.

Anti-tumor antibiotics include (a) anthracydines such as daunorubicin(including liposomal daunorubicin), doxorubicin (including liposomaldoxorubicin), epirubicin, idarubicin, and valrubicin; (b)streptomyces-related agents such as bleomycin, actinomycin, mithramycin,mitomycin, porfiromycin; and (c) anthracenediones, such as mitoxantroneand pixantrone. Anthracyclines have three mechanisms of action:intercalating between base pairs of the DNA/RNA strand; inhibitingtopoiosomerase II enzyme; and creating iron-mediated free oxygenradicals that damage the DNA and cell membranes. Anthracyclines aregenerally characterized as topoisomerase II inhibitors.

Hormonal therapies include (a) androgens such as fluoxymesterone andtestolactone; (b) antiandrogens such as bicalutamide, cyproterone,flutamide, and nilutamide; (c) aromatase inhibitors such asaminoglutethimide, anastrozole, exemestane, formestane, and letrozole;(d) corticosteroids such as dexamethasone and prednisone; (e) estrogenssuch as diethylstilbestrol; (f) antiestrogens such as fulvestrant,raloxifene, tamoxifen, and toremifine; (g) LHRH agonists and antagonistssuch as buserelin, goserelin, leuprolide, and triptorelin; (h)progestins such as medroxyprogesterone acetate and megestrol acetate;and (i) thyroid hormones such as levothyroxine and liothyronine.

Molecular targeted agents include (a) receptor tyrosine kinase (RTK)inhibitors, such as inhibitors of EGFR, including erlotinib, gefitinib,and neratinib; inhibitors of VEGFR including vandetanib, semaxinib, andcediranib; and inhibitors of PDGFR; further included are RTK inhibitorsthat act at multiple receptor sites such as lapatinib, which inhibitsboth EGFR and HER2, as well as those inhibitors that act at of each ofC-kit, PDGFR and VEGFR, including but not limited to axitinib,sunitinib, sorafenib and toceranib; also included are inhibitors ofBCR-ABL, c-kit and PDGFR, such as imatinib; (b) FKBP binding agents,such as an immunosuppressive macrolide antibiotic, including bafdomycin,rapamycin (sirolimus) and everolimus; (c) gene therapy agents, antisensetherapy agents, and gene expression modulators such as the retinoids andrexinoids, e.g. adapalene, bexarotene, trans-retinoic acid, 9 cisretinoic acid, and N (4 hydroxyphenyl)retinamide; (d) phenotype-directedtherapy agents, including: monoclonal antibodies such as alemtuzumab,bevacizumab, cetuximab, ibritumomab tiuxetan, rituximab, andtrastuzumab; (e) immunotoxins such as gemtuzumab ozogamicin; (f)radioimmunoconjugates such as 131I-tositumomab; and (g) cancer vaccines.

Akt inhibitors include, but are not limited to, 1L6Hydroxymethyl-chiro-inositol-2-(R)-2-O-methyl-3-O-octadecyl-sn-glycerocarbonate,SH-5 (Calbiochem Cat. No. 124008), SH-6 (Calbiochem Cat. No. Cat. No.124009), Calbiochem Cat. No. 124011, Triciribine (NSC 154020, CalbiochemCat. No. 124012), 10-(4′-(N-diethylamino)butyl)-2-chlorophenoxazine,Cu(II)Cl2(3-Formylchromone thiosemicarbazone),1,3-dihydro-1-(1-((4-(6-phenyl-1H-imidazo[4,5-g]quinoxalin-7-yl)phenyl)methyl)-4-piperidinyl)-2H-benzimidazol-2-one,GSK690693(4-(2-(4-amino-1,2,5-oxadiazol-3-yl)-1-ethyl-7-{[(3S)-3-piperidinylmethyl]oxy}-1H-imidazo[4,5-c]pyridin-4-yl)-2-methyl-3-butyn-2-ol),SR13668 ((2,10-dicarbethoxy-6-methoxy-5,7-dihydro-indolo[2,3-b]carbazole), GSK2141795, Perifosine, GSK21110183, XL418, XL147,PF-04691502, BEZ-235[2-Methyl-2-[4-(3-methyl-2-oxo-8-quinolin-3-yl-2,3-dihydro-imidazo[4,5-c]quinolin-1-yl)-phenyl]-propionitrile],PX-866 ((acetic acid(1S,4E,10R,11R,13S,14R)-[4-diallylaminomethylene-6-hydroxy-1-methoxymethyl-10,13-dimethyl-3,7,17-trioxo-1,3,4,7,10,11,12,13,14,15,16,17-dodecahydro-2-oxa-cyclopenta[a]phenanthren-11-ylester)), D 106669, CAL-101, GDC0941(2-(1H-indazol-4-yl)-6-(4-methanesulfonyl-piperazin-1-ylmethyl)-4-morpholin-4-yl-thieno[3,2-d]pyrimidine),SF1126, SF1188, SF2523, TG100-115[3-[2,4-diamino-6-(3-hydroxyphenyl)pteridin-7-yl]phenol]. A number ofthese inhibitors, such as, for example, BEZ-235, PX-866, D 106669, CAL101, GDC0941, SF1126, SF2523 are also identified in the art as PI3K/mTORinhibitors; additional examples, such as PI-103[3-[4-(4-morpholinylpyrido[3′,2′:4,5]furo[3,2-d]pyrimidin-2-yl]phenolhydrochloride] are well-known to those of skill in the art. Additionalwell-known PI3K inhibitors include LY294002[2-(4-morpholinyl)-8-phenyl-4H-1-benzopyran-4-one] and wortmannin. mTORinhibitors known to those of skill in the art include temsirolimus,deforolimus, sirolimus, everolimus, zotarolimus, and biolimus A9. Arepresentative subset of such inhibitors includes temsirolimus,deforolimus, zotarolimus, and biolimus A9.

HDAC inhibitors include, but are not limited to, (i) hydroxamic acidssuch as Trichostatin A, vorinostat (suberoylanilide hydroxamic acid(SAHA)), panobinostat (LBH589) and belinostat (PXD101) (ii) cyclicpeptides, such as trapoxin B, and depsipeptides, such as romidepsin (NSC630176), (iii) benzamides, such as MS-275(3-pyridylmethyl-N-{4-[(2-aminophenyl)-carbamoyl]-benzyl}-carbamate),CI994 (4-acetylamino-N-(2aminophenyl)-benzamide) and MGCD0103(N-(2-aminophenyl)-4-((4-(pyridin-3-yl)pyrimidin-2-ylamino)methyl)benzamide), (iv) electrophilicketones, (v) the aliphatic acid compounds such as phenylbutyrate andvalproic acid. In one embodiment, the PI3K inhibitor is Idelalisib(CAL-101).

Hsp90 inhibitors include, but are not limited to, benzoquinoneansamycins such as geldanamycin, 17 DMAG(17-Dimethylamino-ethylamino-17-demethoxygeldanamycin), tanespimycin (17AAG, 17-allylamino-17 demethoxygeldanamycin), EC5, retaspimycin(IPI-504, 18,21 didehydro-17-demethoxy-18,21-dideoxo-18,21-dihydroxy-17-(2 propenylamino)-geldanamycin),and herbimycin; pyrazoles such as CCT 018159(4-[4-(2,3-dihydro-1,4-benzodioxin-6-yl)-5-methyl-1H-pyrazol-3-yl]-6-ethyl-1,3-benzenediol);macrolides, such as radicocol; as well as BIIB021 (CNF2024), SNX-5422,STA-9090, and AUY922.

CDK inhibitors include, but are not limited to, AZD-5438, BMI-1040,BMS-032, BMS-387, CVT-2584, flavopyridol, GPC-286199, MCS-5A, PD0332991,PHA-690509, seliciclib (CYC202, R-roscovitine), ZK-304709 AT7519M,P276-00, SCH 727965, AG-024322, LEE011, LY2835219, P1446A-05, BAY1000394, SNS-032. and the like.

CHK inhibitors include, but are not limited to,5-(3-fluorophenyl)-3-ureidothiophene-N—[(S)-piperidin-3-yl]-2-carboxamide(AZD7762), 7-nitro-1H-indole-2-carboxylic acid{4-[1-(guanidinohydrazone)-ethyl]-phenyl}-amide (PV1019),5-[(8-chloro-3-isoquinolinyl)amino]-3-[(1R)-2-(dimethylamino)-1-methylethoxy]-2-pyrazinecarbonitrile(SAR-020106), PF-00477736, CCT241533,6-bromo-3-(1-methyl-1H-pyrazol-4-yl)-5-(3R)-3-piperidinyl-pyrazolo[1,5-a]pyrimidin-7-amine(SCH900776), 7-hydroxystaurosporine (UCN-01),4-[((3S)-1-azabicyclo[2.2.2]oct-3-yl)amino]-3-(1H-benzimidazol-2-yl)-6-chloroquinolin-2(1H)-one(CHIR 124), 7-aminodactinomycin (7-AAD), isogranulatimide,debromohymenialdisine,N-[5-Bromo-4-methyl-2-[(2S)-2-morpholinylmethoxy]-phenyl]-N′-(5-methyl-2-pyrazinyl)urea)(LY2603618), sulforaphane (4-methylsulfinylbutyl isothiocyanate),9,10,11,12-Tetrahydro-9,12-epoxy-1H-diindolo[1,2,3-fg:3′,2′,1′-kl]pyrrolo[3,4-i][1,6]benzodiazocine-1,3(2H)-dione(SB-218078), TAT-S216A (synthetic peptide; see U.S. Pat. No. 9,415,118,incorporated herein by reference in its entirety), CBP501 (, seeUS20100112089A1, incorporated herein by reference in its entirety), andthe like.

PARP inhibitors include, but are not limited to,4-(3-(1-(cyclopropanecarbonyl)piperazine-4-carbonyl)-4-fluorobenzyl)phthalazin-1(2H)-one (olaparib, AZD2281, Ku-0059436),2-[(2R)-2-methylpyrrolidin-2-yl]-1H-benzimidazole-4-carboxamide(Veliparib, ABT-888),(8S,9R)-5-fluoro-8-(4-fluorophenyl)-9-(1-methyl-1H-1,2,4-triazol-5-yl)-8,9-dihydro-2H-pyrido[4,3,2-de]phthalazin-3(7H)-one(talazoparib, BMN 673), 4-iodo-3-nitrobenzamide (iniparib, BSI-201),8-fluoro-5-(4-((methylamino)methyl)phenyl)-3,4-dihydro-2H-azepino[5,4,3-cd]indol-1(6H)-onephosphoric acid (Rucaparib, AG-014699, PF-01367338),2-[4-[(dimethylamino)methyl]phenyl]-5,6-dihydroimidazo[4,5,1-jk][1,4]benzodiazepin-7(4H)-one(AG14361), 3-aminobenzamide (INO-1001),2-(2-fluoro-4-((S)-pyrrolidin-2-yl)phenyl)-3H-benzo[d]imidazole-4-carboxamide(A-966492), N-(5,6-dihydro-6-oxo-2-phenanthridinyl)-2-acetamidehydrochloride (PJ34, PJ34 HCl), MK-4827,3,4-dihydro-4-oxo-3,4-dihydro-4-oxo-N-[(1S)-1-phenylethyl]-2-quinazolinepropanamide(ME0328), 5-(2-oxo-2-phenylethoxy)-1(2H)-isoquinolinone (UPF-1069),4-[[4-fluoro-3-[(4-methoxy-1-piperidinyl)carbonyl]phenyl]methyl]-1(2H)-phthalazinone(AZD 2461), and the like. In one embodiment, the PARP inhibitor isOlaparib.

Miscellaneous agents include altretamine, arsenic trioxide, galliumnitrate, hydroxyurea, levamisole, mitotane, octreotide, procarbazine,suramin, thalidomide, photodynamic compounds such as methoxsalen andsodium porfimer, and proteasome inhibitors such as bortezomib.

Biologic therapy agents include: interferons such as interferon-α2a andinterferon-α2b, and interleukins such as aldesleukin, denileukindiftitox, and oprelvekin.

In addition to anticancer agents intended to act against cancer cells,combination therapies including the use of protective or adjunctiveagents, including: cytoprotective agents such as armifostine,dexrazonxane, and mesna, phosphonates such as parmidronate andzoledronic acid, and stimulating factors such as epoetin, darbeopetin,filgrastim, PEG-filgrastim, and sargramostim, are also envisioned.

Anti-Angiogenics

Angiogenesis refers to the formation of new blood vessels. Cancer cellsand tumors release chemicals which signal the growth and formation ofnew blood vessels. Angiogenesis plays an important in cell proliferationof cancer and tumor cells because the formations of new blood vesselsallow delivery of necessary nutrition to the growing cells. Angiogenesisinhibitors are important group of chemicals because they can prevent thegrowth of cancer by blocking the formation of new blood vessels fromsurrounding tissue to a solid tumor.

Angiogenesis inhibitors include endothelial-specific receptor tyrosinekinase (Tie-2) inhibitors, epidermal growth factor receptor (EGFR)inhibitors, insulin growth factor-2 receptor (IGFR-2) inhibitors, matrixmetalloproteinase-2 (MMP-2) inhibitors, matrix metalloproteinase-9(MMP-9) inhibitors, platelet-derived growth factor receptor (PDGFR)inhibitors, thrombospondin analogs vascular endothelial growth factorreceptor tyrosine kinase (VEGFR) inhibitors and the like.

Angiogenesis inhibitors may also include, but are not limited to,2-methoxyestradiol, AG3340, prinomastat, batimastat, BAY 12-9566,carboxyamidotriazole, CC-1088, dextromethorphan acetic acid,dimethylxanthenone acetic acid, EMD 121974, endostatin, IM-862,marimastat, matrix metalloproteinase, penicillamine, PTK787/ZK 222584,RPI.4610, squalamine, squalamine lactate,3-[2,4-dimethylpyrrol-5-yl-methyl-idenyl]-2-indolinone (SU5416),(±)-thalidomide, S-thalidomide, R-thalidomide,O-(chloroacetylcarbamoyl)fumagillol (TNP-470), combretastatin,paclitaxel, tamoxifen, COL-3, neovastat, BMS-275291, SU6668, 2-ME,interferon-alpha, anti-VEGF antibody, Medi-522 (Vitaxin II), CAI(inhibitor of calcium influx), celecoxib, Interleukin-12, IM862,amilloride, Angiostatin® protein, angiostatin K1-3, angiostatin K1-5,captopril, DL-alpha-difluoromethylornithine,DL-alpha-difluoromethylomithine HCl, His-Tag® Endostatin™ Protein,fumagillin, herbimycin A, 4-hydroxyphenylretinamide, gamma-interferon,juglone, laminin, laminin hexapeptide, laminin pentapeptide, lavendustinA, medroxyprogesterone, medroxyprogesterone acetate, minocycline,minocycline HCl, placental ribonuclease inhibitor, suramin, sodium saltSuramin, human platelet thrombospondin, tissue inhibitor ofmetalloproteinase 1, neutrophil granulocyte tissue inhibitor ofmetalloproteinase 1, rheumatoid synovial fibroblast tissue inhibitor ofmetalloproteinase 2, and the like.

Radiotherapy

Radiotherapy uses high-energy x-rays given as external beam radiotherapyor internal beam radiotherapy to prevent or reduce further proliferationof cancer cells or to cause apoptosis in cancer cells. Althoughradiotherapy can affect both cancer cells as well as healthy cells,healthy cells are better able to resist or recover from the effects ofradiation.

In one embodiment, radiotherapy may be useful when administered incombination with the administration of a therapeutically effectiveamount of compounds of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof. In someembodiments, radiotherapy may be administered before, during, or after asubject has started or ended a treatment regime comprising atherapeutically effective amount of compounds of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof.

Combination Therapy

In one embodiment, the present invention provides a method of treating acondition associated with cell proliferation in a patient in needthereof. In one embodiment, the present invention provides a method oftreating cancer or tumors. The method comprises co-administering to apatient in need thereof a therapeutically effective amount of at leastone compound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA),and/or their subgenera, or Compound A, or a pharmaceutically acceptablesalt, ester, solvate and/or prodrug thereof and at least one additionaltherapeutically active agent. In some embodiment, at least oneadditional therapeutically active agent is selected from the groupconsisting of immunotherapeutics, anticancer agents, andanti-angeogenics.

In one embodiment, the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,is administered at a dose from about 5 mg/day to about 500 mg/day. Inone embodiment, at least one additional therapeutically active agent isadministered at about 1 mg/day to about 500 mg/day.

In another embodiment, the compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand/or at least one additional therapeutically active agent isadministered at a dose from about 1 mg/m² to about 3 g/m², from about 5mg/m² to about 1 g/m², or from about 10 mg/m² to about 500 mg/m².

The administered dose may be expressed in units of mg/m²/day in which apatient's body surface area (BSA) may be calculated in m² using variousavailable formulae using the patient's height and weight. Theadministered dose may alternatively be expressed in units of mg/daywhich does not take into consideration the patient's BSA. It isstraightforward to convert from one unit to another given a patient'sheight and weight.

The term “co-administration” or “coadministration” refers toadministration of (a) a compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand (b) at least one additional therapeutically active agent, togetherin a coordinated fashion. For example, the co-administration can besimultaneous administration, sequential administration, overlappingadministration, interval administration, continuous administration, or acombination thereof. In one embodiment, a compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof and at least one additional therapeutically active agent areformulated into a single dosage form. In another embodiment, formula(I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof and at least one additional therapeutically active agentare provided in a separate dosage forms.

In one embodiment, the co-administration is carried out for one or moretreatment cycles. By “treatment cycle”, it is meant a pre-determinedperiod of time for co-administering the compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof and at least one therapeutically active agent. Typically, thepatient is examined at the end of each treatment cycle to evaluate theeffect of the present combination therapy. In one embodiment, theco-administration is carried out for 1 to 48 treatment cycles. Inanother embodiment, the co-administration is carried out for 1 to 36treatment cycles. In another embodiment, the co-administration iscarried out for 1 to 24 treatment cycles.

In one embodiment, each of the treatment cycle has about 3 or more days.In another embodiment, each of the treatment cycle has from about 3 daysto about 60 days. In another embodiment, each of the treatment cycle hasfrom about 5 days to about 50 days. In another embodiment, each of thetreatment cycle has from about 7 days to about 28 days. In anotherembodiment, each of the treatment cycle has 28 days. In one embodiment,the treatment cycle has about 29 days. In another embodiment, thetreatment cycle has about 30 days. In another embodiment, the treatmentcycle has about a month-long treatment cycle. In another embodiment, thetreatment cycle has from about 4 to about 6 weeks.

Depending on the patient's condition and the intended therapeuticeffect, the dosing frequency for each of the compound of formula (I),(IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof and at least one therapeutically active agent may varyfrom once per day to six times per day. That is, the dosing frequencymay be once per day, twice per day, three times per day, four times perday, five times per day, or six times per day. In some embodiments,dosing frequency may be one to six times per week or one to four timesper month. In one embodiment, dosing frequency may be once a week, onceevery two weeks, once every three weeks, once every four weeks, or oncea month.

There may be one or more void days in a treatment cycle. By “void day”,it is meant a day when neither the compound of formula (I), (IA), (IB),(II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofor at least one therapeutically active agent is administered. In otherwords, none of the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent is administered on a voidday. Any treatment cycle must have at least one non-void day. By“non-void day”, it is meant a day when at least one of the compound offormula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or a pharmaceutically acceptable salt, ester,solvate and/or prodrug thereof and at least one therapeutically activeagent is administered.

By “simultaneous administration”, it is meant that the compound offormula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or a pharmaceutically acceptable salt, ester,solvate and/or prodrug thereof and at least one therapeutically activeagent are administered on the same day. For the simultaneousadministration, the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent can be administered at thesame time or one at a time.

In one embodiment of the simultaneous administration, the compound offormula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or a pharmaceutically acceptable salt, ester,solvate and/or prodrug thereof, is administered from 1 to 4 times perday, 1 to 4 times per week, once every two weeks, once every threeweeks, once every four weeks or 1 to 4 times per month; and the at leastone additional therapeutically active agent is administered 1 to 4 timesper day, 1 to 4 times per week, once every two weeks, once every threeweeks, once every four weeks or 1 to 4 times per month. In anotherembodiment of the simultaneous administration, the compound of formula(I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof, is administered once a week, once every two weeks, onceevery three weeks, once every four weeks, or once a month; and the atleast one additional therapeutically active agent is administered 1 to 4times per day, 1 to 4 times per week, once every two weeks, once everythree weeks, once every four weeks or 1 to 4 times per month.

By “sequential administration”, it is meant that during a period of twoor more days of continuous co-administration without any void day, onlyone of the compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof and at least onetherapeutically active agent is administered on any given day.

In one embodiment of the sequential administration, the compound offormula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or a pharmaceutically acceptable salt, ester,solvate and/or prodrug thereof, is administered from 1 to 4 times perday, 1 to 4 times per week, once every two weeks, once every threeweeks, once every four weeks or 1 to 4 times per month; and at least oneadditional therapeutically active agent is administered 1 to 4 times perday, 1 to 4 times per week, once every two weeks, once every threeweeks, once every four weeks or 1 to 4 times per month. In anotherembodiment of the sequential administration, the compound of formula(I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof, is administered from once a week, once every two weeks,once every three weeks, once every four weeks, or once a month; and atleast one additional therapeutically active agent is administered 1 to 4times per day, 1 to 4 times per week, once every two weeks, once everythree weeks, once every four weeks or 1 to 4 times per month.

By “overlapping administration”, it is meant that during a period of twoor more days of continuous co-administration without any void day, thereis at least one day of simultaneous administration and at least one daywhen only one of the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent is administered.

By “interval administration”, it is meant a period of co-administrationwith at least one void day. By “continuous administration”, it is meanta period of co-administration without any void day. The continuousadministration may be simultaneous, sequential, or overlapping, asdescribed above.

In the present method, the co-administration comprises oraladministration, parenteral administration, or a combination thereof.Examples of the parenteral administration include, but are not limitedto intravenous (IV) administration, intraarterial administration,intramuscular administration, subcutaneous administration, intraosseousadministration, intrathecal administration, or a combination thereof.The compound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA),and/or their subgenera, or Compound A, or a pharmaceutically acceptablesalt, ester, solvate and/or prodrug thereof and at least onetherapeutically active agent can be independently administered orally orparenterally. In one embodiment, the compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof and at least one therapeutically active agent is administeredparenterally. The parenteral administration may be conducted viainjection or infusion.

In one embodiment of the present method, Compound A is provided for usein combination therapy with at least one additional therapeuticallyactive agent. In one embodiment, the combination therapy involvesco-administration on Compound A and an immunotherapeutic agent, ananticancer agent, or an anti-angiogenics. In another embodiment, thecombination therapy of the present disclosure provides Compound A and atleast one additional therapeutically active agent selected fromnivolumab, pembrolizumab, and ipilimumab.

In one embodiment, Compound A and at least one additionaltherapeutically active agent are orally, subcutaneously, orintravenously administered.

Pharmaceutical Formulations

In another embodiment, the present invention provides a pharmaceuticalcomposition and/or combination comprising a therapeutically effectiveamount of a compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof, as disclosedherein, as the active ingredient, combined with a pharmaceuticallyacceptable excipient or carrier. The excipients are added to theformulation for a variety of purposes.

In some embodiments, the compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent may be formulated into asingle pharmaceutical composition and/or combination. In someembodiments, the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent are formulated into aseparate pharmaceutical composition and/or combination comprising apharmaceutically acceptable excipient or a carrier.

In one embodiment, the at least one therapeutically active agent in thesingle pharmaceutical composition and/or combination composition is animmunotherapeutic, anticancer agent, and/or an anti-angiogenic.

In one embodiment, the immunotherapeutic agent in the composition is amonoclonal antibody, an immune effector cell, adoptive cell transfer, animmunotoxin, a vaccine, and/or a cytokine. In one specific embodiment,the immunotherapeutic agent is cytokine. In one embodiment, the cytokineas is an immunotherapeutic is selected from TNF-α and/or IFN-γ.

In some embodiments the immunotherapeutics in the composition is anantibody or an antigen-binding portion thereof that disrupts theinteraction between PD-1 and PD-L1, thereby attracting T cells to cancercells. In some embodiments, an immunotherapeutic agent in thecomposition is anti-PD-1 antibody, a PD-1 antagonist, an anti-PD-L1antibody, a siRNA targeting expression of PD-1, a siRNA targeting theexpression of PD-L1, or a peptide, fragment, dominant negative form, orsoluble form of PD-1 or PD-L1. In one embodiment, an anti-PD-1 antibodyis a monoclonal antibody and/or a humanized antibody. CytotoxicT-lymphocyte antigen 4 (CTLA4, also known as CD152) is a member of theimmunoglobulin superfamily that is expressed exclusively on T-cells.CTLA4 acts to inhibit T-cell activation and is reported to inhibithelper T-cell activity and enhance regulatory T-cell immunosuppressiveactivity. In some embodiments, an immunotherapeutic in the compositionis an antibody that disrupts CTLA4. In other embodiments, animmunotherapeutic agent in the composition is a CTLA-4 antagonist,anti-CLTA-4 antibody, a siRNA targeting the expression of CTLA-4, or apeptide, fragment, dominant negative form, or soluble form of CTLA-4.Other immunoglobulin superfamily members include, but are not limitedto, CD28, ICOS and BTLA.

In some embodiments, the immunotherapeutic agent in the composition isselected from the group consisting of anti-PD-1 antibody, nivolumab(BMS-936558, ONO-4538), lambrolizumab (MK-3475), pidilizumab (CT-011),alemtuzumab, bevacizumab, brentuximab vedotin, cetuximab, gemtuzumabozogamicin, ibritumomab tiuxetan, ipilimumab, ofatumumab, panitumumab,rituximab, tositumomab, trastuzumab, tremelimumab, lirlumab,trevilizumab, AB134090, 11159-H03H, 11159-H08H, PA5-29572, PA5-23967,PA5-26465, MAI-12205, MAI-35914, AMP-224, MDX-1105, MEDI4736, MPDL3280A,BMS-936559, MIH1, anti-B7-H4, anti-B7-H1, anti-LAG3, BTLA, anti-Tim3,anti-B7-DC, anti-CD160, MR antagonist antibodies, anti-4-1BB, anti-OX40,anti-CD27, CD40 agonist antibodies, clone UC10-4F10-11, clone RPM1-14,clone 9D9, clone 10F.9G2, and the like, and mixtures thereof.

In one embodiment, the immunotherapeutic agent in the composition is ananti-PD-1 antibody. In another embodiment, the immunotherapeutic agentin the composition is nivolumab or pembrolizumab. In other embodiments,the immunotherapeutic agent in the composition is an anti-CTLA-4antibody. In one embodiment, the immunotherapeutic agent in thecomposition is ipilimumab.

In some embodiments, the immunotherapeutic agent in the composition isan antibody that disrupts CTLA4. In other embodiments, theimmunotherapeutic agent in the composition is a CTLA-4 antagonist,anti-CLTA-4 antibody, a siRNA targeting the expression of CTLA-4, or apeptide, fragment, dominant negative form, and/or soluble form ofCTLA-4. Other immunoglobulin superfamily members include, but are notlimited to, CD28, ICOS and BTLA.

In some embodiments, the immunotherapeutic agent in the composition isselected from the group consisting of pidilizumab (CT-011), alemtuzumab,bevacizumab, brentuximab vedotin, cetuximab, gemtuzumab ozogamicin,ibritumomab tiuxetan, ipilimumab, ofatumumab, panitumumab, rituximab,tositumomab, trastuzumab, tremelimumab, lirlumab, trevilizumab,AB134090, 11159-H03H, 11159-H08H, PA5-29572, PA5-23967, PA5-26465,MAI-12205, MAI-35914, AMP-224, MDX-1105, MEDI4736, MPDL3280A,BMS-936559, MIH1, anti-B7-H4, anti-B7-H1, anti-LAG3, BTLA, anti-Tim3,anti-B7-DC, anti-CD160, MR antagonist antibodies, anti-4-1BB, anti-OX40,anti-CD27, CD40 agonist antibodies, clone UC10-4F10-11, clone RPM1-14,clone 9D9, clone 10F.9G2, and the like, and mixtures thereof.

In other embodiments, the immunotherapeutic agent in the composition isan anti-CTLA-4 antibody. In one embodiment, the immunotherapeutic agentin the composition is ipilimumab.

The anticancer agents in the composition of the present application mayinclude agents selected from any of the classes known to those ofordinary skill in the art, including, for example, alkylating agents,anti-metabolites, plant alkaloids and terpenoids (e.g., taxanes),topoisomerase inhibitors, anti-tumor antibiotics, kinase inhibitors,hormonal therapies, molecular targeted agents, and the like. Generallysuch an anticancer agent is an alkylating agent, an anti-metabolite, avinca alkaloid, a taxane, a topoisomerase inhibitor, an anti-tumorantibiotic, a tyrosine kinase inhibitor, an immunosuppressive macrolide,an Akt inhibitor, an HD AC inhibitor an Hsp90 inhibitor, an mTORinhibitor, a PI3K/mTOR inhibitor, a PI3K inhibitor, a CDK(cyclin-dependent kinase) inhibitor, CHK (checkpoint kinase) inhibitor,PARP (poly (DP-ribose)polymerase) inhibitors, and the like.

Alkylating agents in the composition may include (a) alkylating-likeplatinum-based chemotherapeutic agents such as cisplatin, carboplatin,nedaplatin, oxaliplatin, satraplatin, and(SP-4-3)-(cis)-amminedichloro-[2-methylpyridine] platinum(II); (b) alkylsulfonates such as busulfan; (c) ethyleneimine and methylmelaminederivatives such as altretamine and thiotepa; (d) nitrogen mustards suchas chlorambucil, cyclophosphamide, estramustine, ifosfamide,mechlorethamine, trofosamide, prednimustine, melphalan, and uramustine;(e) nitrosoureas such as carmustine, lomustine, fotemustine, nimustine,ranimustine and streptozocin; (f) triazenes and imidazotetrazines suchas dacarbazine, procarbazine, temozolamide, and temozolomide.

Anti-metabolites in the composition may include (a) purine analogs suchas fludarabine, cladribine, chlorodeoxyadenosine, clofarabine,mercaptopurine, pentostatin, and thioguanine; (b) pyrimidine analogssuch as fluorouracil, gemcitabine, capecitabine, cytarabine,azacitidine, edatrexate, floxuridine, and troxacitabine; (c)antifolates, such as methotrexate, pemetrexed, raltitrexed, andtrimetrexate. Anti-metabolites also include thymidylate synthaseinhibitors, such as fluorouracil, raltitrexed, capecitabine, floxuridineand pemetrexed; and ribonucleotide reductase inhibitors such asclaribine, clofarabine and fludarabine.

Plant alkaloid and terpenoid derived agents in the composition mayinclude mitotic inhibitors such as the vinca alkaloids vinblastine,vincristine, vindesine, and vinorelbine; and microtubule polymerstabilizers such as the taxanes, including, but not limited topaclitaxel, docetaxel, larotaxel, ortataxel, and tesetaxel.

Topoisomerase inhibitors in the composition may include topoisomerase Iinhibitors such as camptothecin, topotecan, irinotecan, rubitecan, andbelotecan; and topoisomerase II inhibitors such as etoposide,teniposide, and amsacrine.

Anti-tumor antibiotics in the composition may include (a) anthracyclinessuch as daunorubicin (including liposomal daunorubicin), doxorubicin(including liposomal doxorubicin), epirubicin, idarubicin, andvalrubicin; (b) streptomyces-related agents such as bleomycin,actinomycin, mithramycin, mitomycin, porfiromycin; and (c)anthracenediones, such as mitoxantrone and pixantrone. Anthracyclineshave three mechanisms of action: intercalating between base pairs of theDNA/RNA strand; inhibiting topoiosomerase II enzyme; and creatingiron-mediated free oxygen radicals that damage the DNA and cellmembranes. Anthracyclines are generally characterized as topoisomeraseII inhibitors.

Hormonal therapies in the composition may include (a) androgens such asfluoxymesterone and testolactone; (b) antiandrogens such asbicalutamide, cyproterone, flutamide, and nilutamide; (c) aromataseinhibitors such as aminoglutethimide, anastrozole, exemestane,formestane, and letrozole; (d) corticosteroids such as dexamethasone andprednisone; (e) estrogens such as diethylstilbestrol; (f) antiestrogenssuch as fulvestrant, raloxifene, tamoxifen, and toremifine; (g) LHRHagonists and antagonists such as buserelin, goserelin, leuprolide, andtriptorelin; (h) progestins such as medroxyprogesterone acetate andmegestrol acetate; and (i) thyroid hormones such as levothyroxine andliothyronine.

Molecular targeted agents in the composition may include (a) receptortyrosine kinase (RTK) inhibitors, such as inhibitors of EGFR, includingerlotinib, gefitinib, and neratinib; inhibitors of VEGFR includingvandetanib, semaxinib, and cediranib; and inhibitors of PDGFR; furtherincluded are RTK inhibitors that act at multiple receptor sites such aslapatinib, which inhibits both EGFR and HER2, as well as thoseinhibitors that act at of each of C-kit, PDGFR and VEGFR, including butnot limited to axitinib, sunitinib, sorafenib and toceranib; alsoincluded are inhibitors of BCR-ABL, c-kit and PDGFR, such as imatinib;(b) FKBP binding agents, such as an immunosuppressive macrolideantibiotic, including bafdomycin, rapamycin (sirolimus) and everolimus;(c) gene therapy agents, antisense therapy agents, and gene expressionmodulators such as the retinoids and rexinoids, e.g. adapalene,bexarotene, trans-retinoic acid, 9 cis retinoic acid, and N (4hydroxyphenyl)retinamide; (d) phenotype-directed therapy agents,including: monoclonal antibodies such as alemtuzumab, bevacizumab,cetuximab, ibritumomab tiuxetan, rituximab, and trastuzumab; (e)immunotoxins such as gemtuzumab ozogamicin; (f) radioimmunoconjugatessuch as 131I-tositumomab; and (g) cancer vaccines.

Akt inhibitors in the composition may include, but are not limited to,1L6Hydroxymethyl-chiro-inositol-2-(R)-2-O-methyl-3-O-octadecyl-sn-glycerocarbonate,SH-5 (Calbiochem Cat. No. 124008), SH-6 (Calbiochem Cat. No. Cat. No.124009), Calbiochem Cat. No. 124011, Triciribine (NSC 154020, CalbiochemCat. No. 124012), 10-(4′-(N-diethylamino)butyl)-2-chlorophenoxazine,Cu(II)Cl2(3-Formylchromone thiosemicarbazone),1,3-dihydro-1-(1-((4-(6-phenyl-1H-imidazo[4,5-g]quinoxalin-7yl)phenyl)methyl)-4-piperidinyl)-2H-benzimidazol-2-one,GSK690693(4-(2-(4-amino-1,2,5-oxadiazol-3-yl)-1-ethyl-7-{[(3S)-3-piperidinylmethyl]oxy}-1H-imidazo[4,5-c]pyridin-4-yl)-2-methyl-3-butyn-2-ol),SRI 3668 ((2,10-dicarbethoxy-6-methoxy-5,7-dihydro-indolo[2,3-b]carbazole), GSK2141795, Perifosine, GSK21110183, XL418, XL147,PF-04691502, BEZ-235[2-Methyl-2-[4-(3-methyl-2-oxo-8-quinolin-3-yl-2,3-dihydro-imidazo[4,5-c]quinolin-1-yl)-phenyl]-propionitrile],PX-866 ((acetic acid(1S,4E,10R,11R,13S,14R)-[4-diallylaminomethylene-6-hydroxy-1-methoxymethyl-10,13-dimethyl-3,7,17-trioxo-1,3,4,7,10,11,12,13,14,15,16,17-dodecahydro-2-oxa-cyclopenta[a]phenanthren-11-ylester)), D 106669, CAL-101, GDC0941(2-(1H-indazol-4-yl)-6-(4-methanesulfonyl-piperazin-1-ylmethyl)-4-morpholin-4-yl-thieno[3,2-d]pyrimidine),SF1126, SF1188, SF2523, TG100-115[3-[2,4-diamino-6-(3-hydroxyphenyl)pteridin-7-yl]phenol]. A number ofthese inhibitors, such as, for example, BEZ-235, PX-866, D 106669, CAL101, GDC0941, SF1126, SF2523 are also identified in the art as PI3K/mTORinhibitors; additional examples, such as PI-103[3-[4-(4-morpholinylpyrido[3′,2′:4,5]furo[3,2-d]pyrimidin-2-yl]phenolhydrochloride] are well-known to those of skill in the art. Additionalwell-known PI3K inhibitors in the composition may include LY294002[2-(4-morpholinyl)-8-phenyl-4H-1-benzopyran-4-one] and wortmannin. mTORinhibitors known to those of skill in the art include temsirolimus,deforolimus, sirolimus, everolimus, zotarolimus, and biolimus A9. Arepresentative subset of such inhibitors in the composition may includetemsirolimus, deforolimus, zotarolimus, and/or biolimus A9.

HD AC inhibitors in the composition may include, but are not limited to,(i) hydroxamic acids such as Trichostatin A, vorinostat (suberoylanilidehydroxamic acid (SAHA)), panobinostat (LBH589) and belinostat (PXD101)(ii) cyclic peptides, such as trapoxin B, and depsipeptides, such asromidepsin (NSC 630176), (iii) benzamides, such as MS-275(3-pyridylmethyl-N-{4-[(2-aminophenyl)-carbamoyl]-benzyl}-carbamate),CI994 (4-acetylamino-N-(2aminophenyl)-benzamide) and MGCD0103(N-(2-aminophenyl)-4-((4-(pyridin-3-yl)pyrimidin-2-ylamino)methyl)benzamide),(iv) electrophilic ketones, (v) the aliphatic acid compounds such asphenylbutyrate and valproic acid. In one embodiment, the PI3K inhibitorin the composition is Idelalisib (CAL-101).

Hsp90 inhibitors in the composition may include, but are not limited to,benzoquinone ansamycins such as geldanamycin, 17 DMAG(17-Dimethylamino-ethylamino-17-demethoxygeldanamycin), tanespimycin (17AAG, 17-allylamino-17 demethoxygeldanamycin), EC5, retaspimycin(IPI-504, 18,21didehydro-17-demethoxy-18,21-dideoxo-18,21-dihydroxy-17-(2propenylamino)-geldanamycin), and herbimycin; pyrazoles such as CCT018159(4-[4-(2,3-dihydro-1,4-benzodioxin-6-yl)-5-methyl-1H-pyrazol-3-yl]-6-ethyl-1,3-benzenediol);macrolides, such as radicocol; as well as BIIB021 (CNF2024), SNX-5422,STA-9090, and AUY922.

CDK inhibitors in the composition may include, but are not limited to,AZD-5438, BMI-1040, BMS-032, BMS-387, CVT-2584, flavopyridol,GPC-286199, MCS-5A, PD0332991, PHA-690509, seliciclib (CYC202,R-roscovitine), ZK-304709 AT7519M, P276-00, SCH 727965, AG-024322,LEE011, LY2835219, P1446A-05, BAY 1000394, SNS-032. and the like.

CHK inhibitors in the composition may include, but are not limited to,5-(3-fluorophenyl)-3-ureidothiophene-N—[(S)-piperidin-3-yl]-2-carboxamide(AZD7762), 7-nitro-1H-indole-2-carboxylic acid{4-[1-(guanidinohydrazone)-ethyl]-phenyl}-amide (PV1019),5-[(8-chloro-3-isoquinolinyl)amino]-3-[(1R)-2-(dimethylamino)-1-methylethoxy]-2-pyrazinecarbonitrile(SAR-020106), PF-00477736, CCT241533,6-bromo-3-(1-methyl-1H-pyrazol-4-yl)-5-(3R)-3-piperidinyl-pyrazolo[1,5-a]pyrimidin-7-amine(SCH900776), 7-hydroxystaurosporine (UCN-01),4-[((3S)-1-azabicyclo[2.2.2]oct-3-yl)amino]-3-(1H-benzimidazol-2-yl)-6-chloroquinolin-2(1H)-one(CHIR 124), 7-aminodactinomycin (7-AAD), isogranulatimide,debromohymenialdisine,N-[5-Bromo-4-methyl-2-[(2S)-2-morpholinylmethoxy]-phenyl]-N′-(5-methyl-2-pyrazinyl)urea)(LY2603618), sulforaphane (4-methylsulfinylbutyl isothiocyanate),9,10,11,12-Tetrahydro-9,12-epoxy-1H-diindolo[1,2,3-fg:3′,2′,1′-kl]pyrrolo[3,4-i][1,6]benzodiazocine-1,3(2H)-dione(SB-218078), TAT-S216A (synthetic peptide; YGRKKRRQRRRLYRSPAMPENL),CBP501 ((d-Bpa)sws(d-Phe-F5)(d-Cha)rrrqrr), and the like.

PARP inhibitors in the composition may include, but are not limited to,4-(3-(1-(cyclopropanecarbonyl)piperazine-4-carbonyl)-4-fluorobenzyl)phthalazin-1(2H)-one (olaparib, AZD2281, Ku-0059436),2-[(2R)-2-methylpyrrolidin-2-yl]-1H-benzimidazole-4-carboxamide(Veliparib, ABT-888),(8S,9R)-5-fluoro-8-(4-fluorophenyl)-9-(1-methyl-1H-1,2,4-triazol-5-yl)-8,9-dihydro-2H-pyrido[4,3,2-de]phthalazin-3(7H)-one(talazoparib, BMN 673), 4-iodo-3-nitrobenzamide (iniparib, BSI-201),8-fluoro-5-(4-((methylamino)methyl)phenyl)-3,4-dihydro-2H-azepino[5,4,3-cd]indol-1(6H)-onephosphoric acid (Rucaparib, AG-014699, PF-01367338), 2-[4-[(di methylamino)methyl]phenyl]-5,6-dihydroimidazo[4,5,1-jk][1,4]benzodiazepin-7(4H)-one(AG14361), 3-aminobenzamide (INO-1001),2-(2-fluoro-4-((S)-pyrrolidin-2-yl)phenyl)-3H-benzo[d]imidazole-4-carboxamide(A-966492), N-(5,6-dihydro-6-oxo-2-phenanthridinyl)-2-acetamidehydrochloride (PJ34, PJ34 HCl), MK-4827,3,4-dihydro-4-oxo-3,4-dihydro-4-oxo-N-[(1S)-1-phenylethyl]-2-quinazolinepropanamide(ME0328), 5-(2-oxo-2-phenylethoxy)-1(2H)-isoquinolinone (UPF-1069),4-[[4-fluoro-3-[(4-methoxy-1-piperidinyl)carbonyl]phenyl]methyl]-1(2H)-phthalazinone(AZD 2461), and the like. In one embodiment, the PARP inhibitor in thecomposition is Olaparib.

Other miscellaneous agents in the composition may include altretamine,arsenic trioxide, gallium nitrate, hydroxyurea, levamisole, mitotane,octreotide, procarbazine, suramin, thalidomide, photodynamic compoundssuch as methoxsalen and sodium porfimer, and proteasome inhibitors suchas bortezomib.

Biologic therapy agents in the composition may include: interferons suchas interferon-α2a and interferon-α2b, and interleukins such asaldesleukin, denileukin diftitox, and oprelvekin.

In addition to anticancer agents intended to act against cancer cells,combination therapies including the use of protective or adjunctiveagents in the composition, including: cytoprotective agents such asarmifostine, dexrazonxane, and mesna, phosphonates such as parmidronateand zoledronic acid, and stimulating factors such as epoetin,darbeopetin, filgrastim, PEG-filgrastim, and sargramostim, are alsoenvisioned.

Angiogenesis inhibitors in the composition may includeendothelial-specific receptor tyrosine kinase (Tie-2) inhibitors,epidermal growth factor receptor (EGFR) inhibitors, insulin growthfactor-2 receptor (IGFR-2) inhibitors, matrix metalloproteinase-2(MMP-2) inhibitors, matrix metalloproteinase-9 (MMP-9) inhibitors,platelet-derived growth factor receptor (PDGFR) inhibitors,thrombospondin analogs vascular endothelial growth factor receptortyrosine kinase (VEGFR) inhibitors and the like.

Angiogenesis inhibitors in the composition may also include, but are notlimited to, 2-methoxyestradiol, AG3340, prinomastat, batimastat, BAY12-9566, carboxyamidotriazole, CC-1088, dextromethorphan acetic acid,dimethylxanthenone acetic acid, EMD 121974, endostatin, IM-862,marimastat, matrix metalloproteinase, penicillamine, PTK787/ZK 222584,RPI.4610, squalamine, squalamine lactate,3-[2,4-dimethylpyrrol-5-yl-methyl-idenyl]-2-indolinone (SU5416),(±)-thalidomide, S-thalidomide, R-thalidomide,0-(chloroacetylcarbamoyl)fumagillol (TNP-470), combretastatin,paclitaxel, tamoxifen, COL-3, neovastat, BMS-275291, SU6668, 2-ME,interferon-alpha, anti-VEGF antibody, Medi-522 (Vitaxin II), CAI(inhibitor of calcium influx), celecoxib, Interleukin-12, IM862,amilloride, Angiostatin® protein, angiostatin K1-3, angiostatin K1-5,captopril, DL-alpha-difluoromethylornithine,DL-alpha-difluoromethylomithine HCl, His-Tag® Endostatin™ Protein,fumagillin, herbimycin A, 4-hydroxyphenylretinamide, gamma-interferon,juglone, laminin, laminin hexapeptide, laminin pentapeptide, lavendustinA, medroxyprogesterone, medroxyprogesterone acetate, minocycline,minocycline HCl, placental ribonuclease inhibitor, suramin, sodium saltSuramin, human platelet thrombospondin, tissue inhibitor ofmetalloproteinase 1, neutrophil granulocyte tissue inhibitor ofmetalloproteinase 1, rheumatoid synovial fibroblast tissue inhibitor ofmetalloproteinase 2, and the like.

In a specific embodiment, Compound A, or a pharmaceutically acceptablesalt, ester, solvate and/or prodrug thereof and at least onetherapeutically active agent may be formulated into a singlepharmaceutical composition and/or combination composition. In anotherembodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,as disclosed herein, in an amount of about 5 mg to about 500 mg. Inanother embodiment, the amount is about 20 mg to about 400 mg. Inanother embodiment, the amount is about 50 mg to about 300 mg. Inanother embodiment, the amount is about 100 mg to about 200 mg.

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,and a PARP inhibitor. In another embodiment, the PARP inhibitor isOlaparib.

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand Olaparib, wherein the amount of Olaparib in the composition is about10 mg to about 800 mg. In another embodiment, the amount of Olaparib isabout 20 mg to about 600 mg. In another embodiment, the amount ofOlaparib is about 100 mg to about 500 mg. In another embodiment, theamount of Olaparib is about 300 mg to about 400 mg.

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,and a PI3K inhibitor. In another embodiment, the PI3K inhibitor isIdelalisib.

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand Idelalisib, wherein the amount of Idelalisib in the composition isabout 10 mg to about 500 mg. In another embodiment, the amount ofIdelalisib is about 40 mg to about 300 mg. In another embodiment, theamount of Idelalisib is about 75 mg to about 200 mg. In anotherembodiment, the amount of Idelalisib is about 100 mg to about 175 mg.

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,and one or more immunotherapeutic agent that induces endogenousproduction of cytokines. In another embodiment, the cytokines are TNF-αand/or IFN-γ.

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand an immunotherapeutic agent that induces endogenous production ofTNF-α, wherein the amount of induced TNF-α in the tumor microenvironment(e.g., the physiological level as measured by ELISA) is about is about0.01 ng/ml to about 20 ng/ml. In another embodiment, the amount of TNF-αis about 0.1 ng/ml to about 10 ng/ml. In another embodiment, the amountof TNF-α is about 0.2 ng/ml to about 5 ng/ml. In another embodiment, theamount of TNF-α is about 0.5 ng/ml to about 2 ng/ml. The induced amountof TNF-α can be determined by any suitable method, such as enzyme-linkedimmunosorbent assay (ELISA).

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand an immunotherapeutic agent that induces endogenous production ofIFN-γ, wherein the amount of induced IFN-γ in the tumor microenvironment(e.g., the physiological level as measured by ELISA) is about is about0.01 ng/ml to about 20 ng/ml. In another embodiment, the amount of IFN-γis about 0.1 ng/ml to about 10 ng/ml. In another embodiment, the amountof IFN-γ is about 0.2 ng/ml to about 5 ng/ml. In another embodiment, theamount of IFN-γ is about 0.5 ng/ml to about 2 ng/ml. The induced amountof IFN-γ can be determined by any suitable method, such as enzyme-linkedimmunosorbent assay (ELISA).

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,and an immunotherapeutic agent that induces endogenous secretion ofTNF-α, and IFN-γ in the ranges described above.

In another embodiment, the composition may comprise Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,and an immunotherapeutic agent that induces endogenous secretion ofTNF-α, and/or IFN-γ in the ranges described above, wherein theimmunotherapeutic agent is a PD-1 inhibitor. In another embodiment, thecomposition may comprise Compound A, or a pharmaceutically acceptablesalt, ester, solvate and/or prodrug thereof, and an immunotherapeuticagent that induces endogenous secretion of TNF-α, and/or IFN-γ in theranges described above, wherein the PD-1 inhibitor is nivolumab. In aspecific embodiment, the concentration of nivolumab in the compositionis about 1 mg/mL to about 50 mg/mL. In another embodiment, theconcentration is about 2.5 mg/mL to about 25 mg/mL. In anotherembodiment, the concentration is about 5 mg/mL to about 15 mg/mL. Inanother embodiment, the amount of nivolumab in the composition is about25 mg to about 1,000 mg. In another embodiment, the amount of nivolumabin the composition is about 50 mg to about 500 mg. In anotherembodiment, the amount of nivolumab in the composition is about 150 mgto about 300 mg.

Pharmaceutical acceptable excipients may be added to thecomposition/formulation. For example, diluents may be added to theformulations of the present invention. Diluents increase the bulk of asolid pharmaceutical composition and/or combination, and may make apharmaceutical dosage form containing the composition and/or combinationeasier for the patient and care giver to handle. Diluents for solidcompositions and/or combinations include, for example, microcrystallinecellulose (e.g., AVICEL), microfine cellulose, lactose, starch,pregelatinized starch, calcium carbonate, calcium sulfate, sugar,dextrates, dextrin, dextrose, dibasic calcium phosphate dihydrate,tribasic calcium phosphate, kaolin, magnesium carbonate, magnesiumoxide, maltodextrin, mannitol, polymethacrylates (e.g., EUDRAGIT®),potassium chloride, powdered cellulose, sodium chloride, sorbitol, andtalc.

Solid pharmaceutical compositions and/or combinations that are compactedinto a dosage form, such as a tablet, may include excipients whosefunctions include helping to bind the active ingredient and otherexcipients together after compression. Binders for solid pharmaceuticalcompositions and/or combinations include acacia, alginic acid, carbomer(e.g., carbopol), carboxymethylcellulose sodium, dextrin, ethylcellulose, gelatin, guar gum, gum tragacanth, hydrogenated vegetableoil, hydroxyethyl cellulose, hydroxypropyl cellulose (e.g., KLUCEL),hydroxypropyl methyl cellulose (e.g., METHOCEL), liquid glucose,magnesium aluminum silicate, maltodextrin, methylcellulose,polymethacrylates, povidone (e.g., KOLLIDON, PLASDONE), pregelatinizedstarch, sodium alginate, and starch.

The dissolution rate of a compacted solid pharmaceutical compositionand/or combination in the patient's stomach may be increased by theaddition of a disintegrant to the composition and/or combination.Disintegrants include alginic acid, carboxymethylcellulose calcium,carboxymethylcellulose sodium (e.g., AC-DI-SOL and PRIMELLOSE),colloidal silicon dioxide, croscarmellose sodium, crospovidone (e.g.,KOLLIDON and POLYPLASDONE), guar gum, magnesium aluminum silicate,methyl cellulose, microcrystalline cellulose, polacrilin potassium,powdered cellulose, pregelatinized starch, sodium alginate, sodiumstarch glycolate (e.g., EXPLOTAB), potato starch, and starch.

Glidants can be added to improve the flowability of a non-compactedsolid composition and/or combination and to improve the accuracy ofdosing. Excipients that may function as glidants include colloidalsilicon dioxide, magnesium trisilicate, powdered cellulose, starch,talc, and tribasic calcium phosphate.

When a dosage form such as a tablet is made by the compaction of apowdered composition and/or combination, the composition and/orcombination is subjected to pressure from a punch and dye. Someexcipients and active ingredients have a tendency to adhere to thesurfaces of the punch and dye, which can cause the product to havepitting and other surface irregularities. A lubricant can be added tothe composition and/or combination to reduce adhesion and ease therelease of the product from the dye. Lubricants include magnesiumstearate, calcium stearate, glyceryl monostearate, glycerylpalmitostearate, hydrogenated castor oil, hydrogenated vegetable oil,mineral oil, polyethylene glycol, sodium benzoate, sodium laurylsulfate, sodium stearyl fumarate, stearic acid, talc, and zinc stearate.

Flavoring agents and flavor enhancers make the dosage form morepalatable to the patient. Common flavoring agents and flavor enhancersfor pharmaceutical products that may be included in the compositionand/or combination of the present invention include maltol, vanillin,ethyl vanillin, menthol, citric acid, fumaric acid, ethyl maltol, andtartaric acid.

Solid and liquid compositions and/or combinations may also be dyed usingany pharmaceutically acceptable colorant to improve their appearanceand/or facilitate patient identification of the product and unit dosagelevel.

In liquid pharmaceutical compositions and/or combinations may beprepared using the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,of the present invention and any other solid excipients where thecomponents are dissolved or suspended in a liquid carrier such as water,vegetable oil, alcohol, polyethylene glycol, propylene glycol, orglycerin.

Liquid pharmaceutical compositions and/or combinations may containemulsifying agents to disperse uniformly throughout the compositionand/or combination an active ingredient or other excipient that is notsoluble in the liquid carrier. Emulsifying agents that may be useful inliquid compositions and/or combinations of the present inventioninclude, for example, gelatin, egg yolk, casein, cholesterol, acacia,tragacanth, chondrus, pectin, methyl cellulose, carbomer, cetostearylalcohol, and cetyl alcohol.

Liquid pharmaceutical compositions and/or combinations may also containa viscosity enhancing agent to improve the mouth-feel of the productand/or coat the lining of the gastrointestinal tract. Such agentsinclude acacia, alginic acid bentonite, carbomer, carboxymethylcellulosecalcium or sodium, cetostearyl alcohol, methyl cellulose,ethylcellulose, gelatin guar gum, hydroxyethyl cellulose, hydroxypropylcellulose, hydroxypropyl methyl cellulose, maltodextrin, polyvinylalcohol, povidone, propylene carbonate, propylene glycol alginate,sodium alginate, sodium starch glycolate, starch tragacanth, and xanthangum.

Sweetening agents such as aspartame, lactose, sorbitol, saccharin,sodium saccharin, sucrose, aspartame, fructose, mannitol, and invertsugar may be added to improve the taste.

Preservatives and chelating agents such as alcohol, sodium benzoate,butylated hydroxyl toluene, butylated hydroxyanisole, andethylenediamine tetraacetic acid may be added at levels safe foringestion to improve storage stability.

A liquid composition and/or combination may also contain a buffer suchas gluconic acid, lactic acid, citric acid or acetic acid, sodiumgluconate, sodium lactate, sodium citrate, or sodium acetate. Selectionof excipients and the amounts used may be readily determined by theformulation scientist based upon experience and consideration ofstandard procedures and reference works in the field.

The solid compositions and/or combination of the present inventioninclude powders, granulates, aggregates and compacted compositionsand/or combinations. The dosages include dosages suitable for oral,buccal, rectal, parenteral (including subcutaneous, intramuscular, andintravenous), inhalant and ophthalmic administration. Although the mostsuitable administration in any given case will depend on the nature andseverity of the condition being treated, the most preferred route of thepresent invention is oral. The dosages may be conveniently presented inunit dosage form and prepared by any of the methods well-known in thepharmaceutical arts.

Dosage forms include solid dosage forms like tablets, powders, capsules,suppositories, sachets, troches and lozenges, as well as liquid syrups,suspensions, aerosols and elixirs.

The dosage form of the present invention may be a capsule containing thecomposition and/or combination, preferably a powdered or granulatedsolid composition and/or combination of the invention, within either ahard or soft shell. The shell may be made from gelatin and optionallycontain a plasticizer such as glycerin and sorbitol, and an opacifyingagent or colorant.

A composition and/or combination for tableting or capsule filling may beprepared by wet granulation. In wet granulation, some or all of theactive ingredients and excipients in powder form are blended and thenfurther mixed in the presence of a liquid, typically water that causesthe powders to clump into granules. The granulate is screened and/ormilled, dried and then screened and/or milled to the desired particlesize. The granulate may be tableted, or other excipients may be addedprior to tableting, such as a glidant and/or a lubricant.

A tableting composition and/or combination may be preparedconventionally by dry blending. For example, the blended compositionand/or combination of the actives and excipients may be compacted into aslug or a sheet and then comminuted into compacted granules. Thecompacted granules may subsequently be compressed into a tablet.

As an alternative to dry granulation, a blended composition and/orcombination may be compressed directly into a compacted dosage formusing direct compression techniques. Direct compression produces a moreuniform tablet without granules. Excipients that are particularly wellsuited for direct compression tableting include microcrystallinecellulose, spray dried lactose, dicalcium phosphate dihydrate andcolloidal silica. The proper use of these and other excipients in directcompression tableting is known to those in the art with experience andskill in particular formulation challenges of direct compressiontableting.

A capsule filling of the present invention may comprise any of theaforementioned blends and granulates that were described with referenceto tableting; however, they are not subjected to a final tableting step.

The active ingredient and excipients may be formulated into compositionsand/or combinations and dosage forms according to methods known in theart.

In one embodiment, a dosage form may be provided as a kit comprising acompound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/ortheir subgenera, or Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof and pharmaceutically acceptableexcipients and carriers as separate components. In one embodiment, adosage form may be provided as a kit comprising compound of formula (I),(IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof, at least one additional therapeutically active agent,and pharmaceutically acceptable excipients and carriers as separatecomponents. In some embodiments, the dosage form kit allow physiciansand patients to formulate an oral solution or injection solution priorto use by dissolving, suspending, or mixing the compound of formula (I),(IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofwith pharmaceutically acceptable excipients and carriers. In oneembodiment, a dosage form kit which provides a compound of formula (I),(IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof which has improved stability when compared topre-formulated formulations a compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof.

In one embodiment, a compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofis used in the formulation. The compound of formula (I), (IA), (IB),(II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,of the present invention may be used in pharmaceutical formulations orcompositions and/or combinations as single components or mixturestogether with other forms of a compound of formula (I), (IA), (IB),(II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A. Inone embodiment, pharmaceutical formulations or compositions and/orcombinations of the present invention contain 25-100% or 50-100% byweight, of at least one compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,as described herein, in the formulation or composition and/orcombination.

Therapeutic Use

The present invention also provides treatment of disorders related toproliferation of cells. In one embodiment, there is provided a methodfor selectively activating p53 protein comprising contacting a cellafflicted by disorder related to cell proliferation with the presentcompound. In one embodiment, the method comprises contacting cancerand/or tumor cells with the compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,as disclosed herein. In another embodiment, the method comprisescontacting cancer and/or tumor cells with the compound of formula (I),(IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof and at least one therapeutically active agent, asdisclosed herein.

In another embodiment, the method of contacting cancer and/or tumorcells with the compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof, as disclosedherein, may induce cell apoptosis or alleviate or prevent theprogression of the disorder. In one embodiment, the method of contactingcancer and/or tumor cells with the compound of formula (I), (IA), (IB),(II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent, as disclosed herein, mayinduce cell apoptosis or alleviate or prevent the progression of thedisorder.

In another embodiment, the method of contacting cancer and/or tumorcells with the compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof, as disclosedherein, may reduce the incidence of cancer and/or tumor growth.Additionally, disclosed are methods for treating cancers, cancer cells,tumors, or tumor cells. Non limiting examples of cancer that may betreated by the methods of this disclosure include cancer or cancer cellsof: colorectum, breast, ovary, cervix, lung, liver, pancreas, lymphnode, colon, prostate, brain, head and neck, skin, kidney, bone (e.g.,Ewing's sarcoma) and blood and heart (e.g., leukemia, lymphoma,carcinoma). Non limiting examples of tumors that may be treated by themethods of this disclosure include tumors and tumor cells of:colorectum, breast, ovary, cervix, lung, liver, pancreas, lymph node,colon, prostate, brain, head and neck, skin, kidney, bone (e.g., Ewing'ssarcoma) and blood and heart (e.g., leukemia, lymphoma, carcinoma).

In one embodiment, the present invention provides a method of reducingor inhibiting cell proliferation, and/or a method of treating cancercomprising co-administering to a patient in need thereof atherapeutically effective amount of at least one compound of formula(I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof and a PI3K inhibitor. In one embodiment of variousmethods disclosed herein, a co-administration comprises Compound A and aPI3K inhibitor. In one embodiment, a co-administration for any methoddisclosed herein comprises Compound A and Idelalisib.

In one embodiment, the present invention provides a method of reducingor inhibiting cell proliferation, and/or a method of treating cancercomprising co-administering to a patient in need thereof atherapeutically effective amount of at least one compound of formula(I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof and a PARP inhibitor. In one embodiment of variousmethods disclosed herein, a co-administration comprises Compound A andPARP inhibitor. In one embodiment, a co-administration for any methoddisclosed herein comprises Compound A and Olaparib.

In one embodiment, the present invention provides a method of reducingor inhibiting cell proliferation, and/or a method of treating cancercomprising co-administering to a patient in need thereof atherapeutically effective amount of at least one compound of formula(I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof and cytokines. In one embodiment of various methodsdisclosed herein, a co-administration comprises Compound A andcytokines. In one embodiment, a co-administration for any methoddisclosed herein comprises Compound A and TNF-α. In another embodiment,a co-administration for any method disclosed herein comprises Compound Aand IFN-γ. In another embodiment, the methods may include reducing orinhibiting cell proliferation, and/or a method of treating cancercomprising co-administering to a patient in need thereof atherapeutically effective amount of Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof and at least onetherapeutically active agent in a single pharmaceutical compositionand/or combination composition. In one embodiment, the methods mayinclude reducing or inhibiting cell proliferation, and/or a method oftreating cancer comprising co-administering to a patient in need thereofa therapeutically effective amount of Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof, as disclosedherein, in an amount of about 5 mg to about 500 mg. In anotherembodiment, the amount is about 20 mg to about 400 mg. In anotherembodiment, the amount is about 50 mg to about 300 mg. In anotherembodiment, the amount is about 100 mg to about 200 mg.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof, and a PARP inhibitor. In anotherembodiment, the PARP inhibitor is Olaparib.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof and Olaparib, wherein the amountof Olaparib in the composition is about 10 mg to about 800 mg. Inanother embodiment, the amount of Olaparib is about 20 mg to about 600mg. In another embodiment, the amount of Olaparib is about 100 mg toabout 500 mg. In another embodiment, the amount of Olaparib is about 300mg to about 400 mg.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof, and a PI3K inhibitor. In anotherembodiment, the PI3K inhibitor is Idelalisib.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof and Idelalisib, wherein the amountof Idelalisib in the composition is about 10 mg to about 500 mg. Inanother embodiment, the amount of Idelalisib is about 40 mg to about 300mg. In another embodiment, the amount of Idelalisib is about 75 mg toabout 200 mg. In another embodiment, the amount of Idelalisib is about100 mg to about 175 mg.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof, and an immunotherapeutic agentthat modulates the endogenous secretion of one or more cytokines. Inanother embodiment, the cytokines are TNF-α and/or IFN-γ.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof and an immunotherapeutic agentthat induces endogenous secretion of TNF-α, wherein the amount ofinduced TNF-α is about 0.01 ng/ml to about 20 ng/ml. In anotherembodiment, the amount of induced TNF-α is about 0.1 ng/ml to about 10ng/ml. In another embodiment, the amount of induced TNF-α is about 0.2ng/ml to about 5 ng/ml. In another embodiment, the amount of inducedTNF-α is about 0.5 ng/ml to about 2 ng/ml. The amount of inducedendogenous production of TNF-α can be quantified by any suitable method,such as ELISA.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof and an immunotherapeutic agentthat induces endogenous secretion of IFN-γ, wherein the amount ofinduced IFN-γ is about 0.01 ng/ml to about 20 ng/ml. In anotherembodiment, the amount of induced IFN-γ is about 0.1 ng/ml to about 10ng/ml. In another embodiment, the amount of induced IFN-γ is about 0.2ng/ml to about 5 ng/ml. In another embodiment, the amount of inducedIFN-γ is about 0.5 ng/ml to about 2 ng/ml. The amount of inducedendogenous production of IFN-γ can be quantified by any suitable method,such as ELISA.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof, and an immunotherapeutic agentthat induces endogenous secretion of TNF-α, and/or IFN-γ in the rangesdescribed above.

In another embodiment, the methods may include reducing or inhibitingcell proliferation, and/or a method of treating cancer comprisingco-administering to a patient in need thereof a therapeuticallyeffective amount of Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof, and an immunotherapeutic agentthat induces endogenous secretion of TNF-α, and/or IFN-γ in the rangesdescribed above, wherein the immunotherapeutic agent is a PD-1inhibitor. In another embodiment, the methods may include reducing orinhibiting cell proliferation, and/or a method of treating cancercomprising co-administering to a patient in need thereof atherapeutically effective amount of Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof, and animmunotherapeutic agent that induces endogenous secretion of TNF-α,and/or IFN-γ in the ranges described above, wherein the PD-1 inhibitoris nivolumab. In a specific embodiment, the concentration of nivolumabin the composition is about 1 mg/mL to about 50 mg/mL. In anotherembodiment, the concentration is about 2.5 mg/mL to about 25 mg/mL. Inanother embodiment, the concentration is about 5 mg/mL to about 15mg/mL. In another embodiment, the amount of nivolumab in the compositionis about 25 mg to about 1,000 mg. In another embodiment, the amount ofnivolumab in the composition is about 50 mg to about 500 mg. In anotherembodiment, the amount of nivolumab in the composition is about 150 mgto about 300 mg.

In one embodiment, the co-administration of Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,with Olaparib, Idelalisib, or an immunotherapeutic agent that inducesendogenous secretion of TNF-α and/or IFN-γ to a patient in thereof maybe performed once daily, twice daily, three times daily, four timesdaily, five times daily, six times daily, seven times daily, eight timesdaily, nine times daily, or ten times daily.

In some embodiments, the cancer that can be treated by the methodsprovided in this disclosure is a homologous recombination dependentdeoxyribonucleic acid double strand break repair (HR dependent DNA DSBrepair) deficient cancer, also referred to as HRD cancer. In someembodiments, HR dependent DNA DSB repair deficient cancer is identifiedby determining the HR dependent DNA DSB repair activity of cancer cellsobtained from subject.

In one embodiment, compositions and/or combinations disclosed herein isuseful for treating HRD cancer. In one embodiment, co-administering ofan effective amount of at least one compound of formula (I), (IA), (IB),(II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent can be useful for treatingHRD cancer. In another embodiment, co-administering of an effectiveamount of at least one compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one therapeutically active agent selected from PI3Kinhibitor, PARP inhibitor, and cytokines can be useful for treating HRDcancer. In another embodiment, co-administration of Compound A and atleast one therapeutically active agent selected from PI3K inhibitor,PARP inhibitor, and cytokines can be useful for treating HRD cancer.

The present invention also provides methods of treating, preventing,ameliorating and/or alleviating the progression of disorders orconditions characterized by cell proliferation in a subject. Moreparticularly, the methods of the present invention involveadministration of an effective amount of the quinolone compoundsdescribed herein, in a subject to treat a disorder or a conditioncharacterized by cell proliferation. The compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof, can be administered in an amount effective selectively activatep53 proteins in cancer and/or tumor cells, which may lead to cell deathor apoptosis. The terms “subject” and “patient” are used interchangeablythroughout the present application.

As used herein, administering can be effected or performed using any ofthe various methods known to those skilled in the art. The compound offormula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or a pharmaceutically acceptable salt, ester,solvate and/or prodrug thereof, can be administered, for example,subcutaneously, intravenously, parenterally, intraperitoneally,intradermally, intramuscularly, topically, enteral (e.g., orally),rectally, nasally, buccally, sublingually, vaginally, by inhalationspray, by drug pump or via an implanted reservoir in dosage formulationscontaining conventional non-toxic, physiologically acceptable carriersor vehicles.

Further, the presently disclosed compound of formula (I), (IA), (IB),(II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,can be administered to a localized area in need of treatment. This canbe achieved by, for example, and not by way of limitation, localinfusion during surgery, topical application, transdermal patches, byinjection, by catheter, by suppository, or by implant (the implant canoptionally be of a porous, non-porous, or gelatinous material),including membranes, such as silastic membranes or fibers.

The form in which the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,is administered (e.g., syrup, elixir, capsule, tablet, foams, emulsion,gel, etc.) will depend in part on the route by which it is administered.For example, for mucosal (e.g., oral mucosa, rectal, intestinal mucosa,bronchial mucosa) administration, nose drops, aerosols, inhalants,nebulizers, eye drops or suppositories can be used. The compound offormula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or a pharmaceutically acceptable salt, ester,solvate and/or prodrug thereof, can also be used to coat bioimplantablematerials to enhance neurite outgrowth, neural survival, or cellularinteraction with the implant surface. The compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof, disclosed herein can be administered together with otherbiologically active agents, such as anticancer agents, analgesics,anti-inflammatory agents, anesthetics and other agents which can controlone or more symptoms or causes of a disorder or a conditioncharacterized by cell proliferation.

In one embodiment, the compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand additional therapeutically active agent can be administered togetherwith a second therapeutically active agent or more. In one embodiment,the second therapeutically active agent is an anticancer agent. In someembodiments, one or more therapeutically active anticancer agentincludes, but is not limited to, paclitaxel, vinblastine, vincristine,etoposide, doxorubicin, herceptin, lapatinib, gefitinib, erlotinib,tamoxifen, fulvestrant, anastrazole, lectrozole, exemestane, fadrozole,cyclophosphamide, taxotere, melphalan, chlorambucil, mechlorethamine,chlorambucil, phenylalanine, mustard, cyclophosphamide, ifosfamide,carmustine (BCNU), lomustine (CCNU), streptozotocin, busulfan, thiotepa,cisplatin, carboplatin, dactinomycin (actinomycin D), doxorubicin(adriamycin), daunorubicin, idarubicin, mitoxantrone, plicamycin,mitomycin, C Bleomycin, combinations thereof, and the like.

Additionally, administration can comprise administering to the subject aplurality of dosages over a suitable period of time. Such administrationregimens can be determined according to routine methods, upon a reviewof the instant disclosure.

Compound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/ortheir subgenera, or Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof of the invention are generallyadministered in a dose of about 0.01 mg/kg/dose to about 100 mg/kg/dose.Alternately the dose can be from about 0.1 mg/kg/dose to about 10mg/kg/dose; or about 1 mg/kg/dose to 10 mg/kg/dose. Time releasepreparations may be employed or the dose may be administered in as manydivided doses as is convenient. When other methods are used (e.g.intravenous administration), the compound of formula (I), (IA), (IB),(II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereof,are administered to the affected tissue at a rate from about 0.05 toabout 10 mg/kg/hour, alternately from about 0.1 to about 1 mg/kg/hour.Such rates are easily maintained when the compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof, are intravenously administered as discussed herein. Generally,topically administered formulations are administered in a dose of about0.5 mg/kg/dose to about 10 mg/kg/dose range. Alternately, topicalformulations are administered at a dose of about 1 mg/kg/dose to about7.5 mg/kg/dose or even about 1 mg/kg/dose to about 5 mg/kg/dose.

A range of from about 0.1 to about 100 mg/kg is appropriate for a singledose. Continuous administration is appropriate in the range of about0.05 to about 10 mg/kg.

Drug doses can also be given in milligrams per square meter of bodysurface area rather than body weight, as this method achieves a goodcorrelation to certain metabolic and excretionary functions. Moreover,body surface area can be used as a common denominator for drug dosage inadults and children as well as in different animal species (Freireich etal., (1966) Cancer Chemother Rep. 50, 219-244). Briefly, to express amg/kg dose in any given species as the equivalent mg/sq m dose, thedosage is multiplied by the appropriate km factor. In an adult human,100 mg/kg is equivalent to 100 mg/kg×37 kg/sq m=3700 mg/m².

A dosage form of the present invention may contain a compound of formula(I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or their subgenera, orCompound A, or a pharmaceutically acceptable salt, ester, solvate and/orprodrug thereof, as disclosed herein, in an amount of about 5 mg toabout 500 mg. That is, a dosage form of the present invention maycontain Compound A in an amount of about 5 mg, 10 mg, 15 mg, 20 mg, 25mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 110 mg, 120 mg, 125 mg, 130 mg,140 mg, 150 mg, 160 mg, 170 mg, 175 mg, 180 mg, 190 mg, 200 mg, 210 mg,220 mg, 225 mg, 230 mg, 240 mg, 250 mg, 260 mg, 270 mg, 275 mg, 280 mg,290 mg, 300 mg, 310 mg, 320 mg, 325 mg, 330 mg, 340 mg, 350 mg, 360 mg,370 mg, 375 mg, 380 mg, 390 mg, 400 mg, 410 mg, 420 mg, 425 mg, 430 mg,440 mg, 450 mg, 460 mg, 470 mg, 475 mg, 480 mg, 490 mg, or 500 mg.

A dosage form of the present invention may be administered, hourly,daily, weekly, or monthly. The dosage form of the present invention maybe administered twice a day or once a day. The dosage form of thepresent invention may be administered with food or without food.

Insofar as the compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof forms disclosedherein can take the form of a mimetic or fragment thereof, it is to beappreciated that the potency, and therefore dosage of an effectiveamount can vary. However, one skilled in the art can readily assess thepotency of the compound of formula (I), (IA), (IB), (II), (IIA), (III),(IIIA), and/or their subgenera, or Compound A, or a pharmaceuticallyacceptable salt, ester, solvate and/or prodrug thereof of the typepresently envisioned by the present application.

In settings of a gradually progressive disorder or conditioncharacterized by cell proliferation, the compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof and at least one additional therapeutically active agent aregenerally administered on an ongoing basis. In certain settingsadministration of a compound of formula (I), (IA), (IB), (II), (IIA),(III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one additional therapeutically active agent disclosedherein can commence prior to the development of disease symptoms as partof a strategy to delay or prevent the disease. In other settings thecompound of formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/ortheir subgenera, or Compound A, or a pharmaceutically acceptable salt,ester, solvate and/or prodrug thereof and at least one additionaltherapeutically active agent disclosed herein is administered after theonset of disease symptoms as part of a strategy to slow or reverse thedisease process and/or part of a strategy to improve cellular functionand reduce symptoms.

It will be appreciated by one of skill in the art that dosage range willdepend on the particular compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one additional therapeutically active agent, and itspotency. The dosage range is understood to be large enough to producethe desired effect in which the neurodegenerative or other disorder andthe symptoms associated therewith are ameliorated and/or survival of thecells is achieved, but not be so large as to cause unmanageable adverseside effects. It will be understood, however, that the specific doselevel for any particular patient will depend on a variety of factorsincluding the activity of the specific compound of formula (I), (IA),(IB), (II), (IIA), (III), (IIIA), and/or their subgenera, or Compound A,or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof, employed; the age, body weight, general health, sex and diet ofthe individual being treated; the time and route of administration; therate of excretion; other drugs which have previously been administered;and the severity of the particular disease undergoing therapy, as iswell understood by those skilled in the art. The dosage can also beadjusted by the individual physician in the event of any complication.No unacceptable toxicological effects are expected when Compound Adisclosed herein are used in accordance with the present application.

An effective amount of the compound of formula (I), (IA), (IB), (II),(IIA), (III), (IIIA), and/or their subgenera, or Compound A, or apharmaceutically acceptable salt, ester, solvate and/or prodrug thereofand at least one additional therapeutically active agent disclosedherein comprise amounts sufficient to produce a measurable biologicalresponse. Actual dosage levels of active ingredients of the presentapplication can be varied so as to administer an amount of the compoundof formula (I), (IA), (IB), (II), (IIA), (III), (IIIA), and/or theirsubgenera, or Compound A, or a pharmaceutically acceptable salt, ester,solvate and/or prodrug thereof and at least one additionaltherapeutically active agent that is effective to achieve the desiredtherapeutic response for a particular subject and/or application.Preferably, a minimal dose is administered, and the dose is escalated inthe absence of dose-limiting toxicity to a minimally effective amount.Determination and adjustment of a therapeutically effective dose, aswell as evaluation of when and how to make such adjustments, are knownto those of ordinary skill in the art.

The following examples further illustrate the present invention butshould not be construed as in any way limiting its scope.

EXAMPLES Example 1: Anti-Proliferation Assay

Three human Lymphoma cell lines Toledo, MCI 16 and HT were purchasedfrom the Bioresource Collection and Research Center (BCRC, Taiwan). Allcells were incubated in a humidified atmosphere containing 5% CO₂ at 37°C.

CAL-101, also known as Idelalisib, is a PI3K-delta inhibitor withpotential immunomodulating and antineoplastic activities. Anticanceractivity of the combination of Compound A and CAL-101 on three humanLymphoma cell lines (Toledo, MCI 16, HT) was assessed using in vitrocell proliferation assay. Cell proliferation of drug-treated humancancer cells was determined at 96 hours post-treatment using the MTS(Promega) colorimetric assay. 50% inhibitory concentrations (IC₅₀) and25% IC (IC₂₅) of a tested compound was calculated using GraphPad Prismsoftware. The anti-proliferative effects of Compound A in single andcombination treatments on three cell lines are shown in Tables 1-4.

Corrected absorbance values were obtained by subtracting the average 490nm absorbance of the control wells (medium only, no cell) from all otherabsorbance values. Percentage inhibition of cell growth for compoundtreatment was calculated using this formula:

${\%\mspace{14mu}{inhibition}} = {\left\lbrack {1 - \frac{{OD}_{490}\mspace{14mu}{value}\mspace{14mu}{in}\mspace{14mu}{treated}\mspace{14mu}{well}}{{Average}\mspace{14mu}{OD}_{490}\mspace{14mu}{value}\mspace{14mu}{in}\mspace{14mu}{mock}\mspace{14mu}{control}\mspace{14mu}{well}}} \right\rbrack \times 100}$

The sigmoidal dose-response curve is generated by fitting the percentageinhibition value as a function of logarithm of compound concentrationsusing GraphPad Prism software. IC₅₀ values are defined as theconcentration needed for a 50% inhibition of cell growth. IC₂₅ valuesare defined as the concentration needed for a 25% inhibition of cellgrowth. All data represent the results of triplicate experiments.

Single Compound Treatment

The results indicated Compound A effectively inhibits cell proliferationof all three human Lymphoma cell lines, with IC₅₀ values ranging from45.9 to 723.1 nM. Compound A exhibited the greatest inhibition effect onToledo cell (IC₅₀ is 45.9 nM) and less potently on MCI 16 and HT cell(IC₅₀ is 723.1 and 525.5 nM, respectively). CAL-101 only exertsanti-proliferative effect against Toledo cell (IC₅₀ is 76.0 nM), and isinsensitive to other two cell lines (IC₅₀ greater than 10 μM). Theanti-proliferative effects of Compound A or CAL-101 were assessed andestimated IC₅₀ and IC₂₅ values are summarized in Table 1.

TABLE 1 Estimated IC₅₀ and IC₂₅ of the single drug treatment on 3 celllines Compounds Cell Line (nM) Compound A CAL-101 Toledo IC₅₀ 45.9 ± 2.3 76.0 ± 44.8 IC₂₅ 15.3 ± 0.8  25.3 ± 14.9 MC116 IC₅₀ 723.1 ± 19.5117860.0 ± 29613.6 IC₂₅ 241.0 ± 6.5  39286.7 ± 9871.2 HT IC₅₀ 525.5 ±19.9 10072.0 ± 1383.1 IC₂₅ 175.1 ± 6.6  3357.3 ± 461.0

Estimated IC₅₀ and IC₂₅ values were calculated based on non-linearregression of the dose-response curves of the cell proliferation ratio(%) as a function of logarithm of drug concentrations in singletreatments.

Two-Compound Combination Treatment

The two-drug combination treatments on the cell proliferations wereperformed using three human Lymphoma cell lines (Toledo, MCI 16 and HT).CAL-101 was combined with Compound A at concentration close to theirestimated IC₅₀ and IC₂₅. The anti-proliferative effects of Compound A insingle and combination treatments on three cell lines are shown inTables 2-4. As IC₂₅ value has shown, combination treatment with CompoundA and CAL-101 synergistically enhanced anti-proliferative activity inMCI 16 and HT cells.

TABLE 2 Anti-Proliferative activity of Compound A in single andcombination treatments on Toledo cell lines Toledo cell Compound A +Compounds Compound A CAL-101 CAL-101 IC₅₀ conc. used (nM) 50 — 50 — 400400 Inhibition* (%) 25.6 ± 2.5 49.6 ± 1.7 66.0 ± 2.8 *Inhibition (%)showed the IC₅₀ value for proliferation inhibition in the Toledo cell.

TABLE 3 Anti-Proliferative activity of Compound A in single andcombination treatments on MC116 cell lines MC116 cell Compound A +Compounds Compound A CAL-101 CAL-101 IC₅₀ conc. used (nM) 450 —  450 —35000 35000 Inhibition* (%) 83.4 ± 1.2 70.4 ± 3.1 100.7 ± 1.4 IC₂₅ conc.used (nM) 150 —  150 — 17500 17500 Inhibition* (%) 44.3 ± 5.5  9.2 ± 3.4 88.0 ± 1.6 *Inhibition (%) showed the IC₅₀ value for proliferationinhibition in the MC116 cell.

TABLE 4 Anti-Proliferative activity of Compound A in single andcombination treatments on HT cell lines HT cell Compound A + CompoundsCompound A CAL-101 CAL-101 IC₅₀ conc. used (nM) 400   — 400 — 8000  8000 Inhibition* (%) 41.2 ± 1.9 37.6 ± 1.5 70.5 ± 1.8 IC₂₅ conc. used(nM) 133.3 — 133.3 — 2666.7 2666.7 Inhibition* (%) 15.2 ± 0.9 19.7 ± 4.351.5 ± 3.6 *Inhibition (%) showed the IC₅₀ value for proliferationinhibition in the HT cell.

Example 2: Analysis of Combination Assays

Combination interactions across the dose matrix were determined by theLoewe Additivity model using Horizon's Chalice™ Combination AnalysisSoftware as outlined in the user manual:(http://chalice.horizondiscovery.com/chalice-portal/documentation/analyzer/home.jsp).

Synergy is determined by comparing the experimentally observed level ofinhibition at each combination point with the value expected foradditivity, which is derived from the single-agent responses along theedges of the matrix. Using Chalice™, potential synergistic interactionsare visualized by plotting the calculated excess inhibition overexpected, at each test point in the matrix, as a heat map, wherebrighter/warmer colours are indicative of higher activity levels.

The overall combination interactions can be scored using a simple volumescore, which calculates the volume between the measured and thepredicted response surface. This volume score shows whether the overallresponse to a combination is synergistic (positive values), antagonistic(negative values) or additive (values ˜0).

Drug Combination Study

The effect of combining Compound A with Olaparib was assessed in DLD1Parental and DLD1-BRCA2 (−/−) isogenic cell lines across a matrix ofconcentrations using the Loewe Additivity model with Horizon's Chalice™combination analysis software. The activity of the compounds wasevaluated with short (48 hr) and long (6 d, 144 hr) treatment time.

Using Chalice™, potential synergistic interactions were visualized byplotting the calculated excess inhibition over expected, at each testpoint in the matrix, as a heat map, where brighter/warmer colours areindicative of higher activity levels (FIGS. 1A-B and 2A-B).

Volume scores for this combination in both cell lines were positive,which further confirm that the interaction is synergistic (positivevalues) and (values ˜0). Volume and synergy scores for the combinationin both lines are shown in FIGS. 1C-D and 2C-D and Table 5.

In Vivo Validation of PARP Inhibitor and Compound a CombinationTreatment

In comparison with PARP inhibitor Olaparib alone treatment, combinationtreatment of Olaparib (50 mg/kg) and Compound A (50 mg/kg) significantlyinhibited tumor growth of BRCA2-deficient triple-negative breast cancer(TNBC) patient-derived xenograft (PDX) model (FIGS. 3A-3B), confirmingthat the ability of Compound A to synergize with PARPi in vivo isassociated with DNA repair pathways in tumors. In addition, we treatedmice implanted with TNBC xenografts to Olaparib (50 mg, qd×28), followedby 2 subsequent doses of Compound A (50 mg qwk×2) followed by 7subsequent doses of Olaparib (50 mg, qd×7) (FIGS. 3B-3C). A two-stagetreatment system including Olaparib pre-treatment (FIG. 3B) or posttreatment (FIG. 3C) demonstrated significant anti-tumor activity.

TABLE 5 Volume and synergy scores for the combination in DLD1 Parentaland BRCA2 (−/−) isogenic cell lines 48 h 144 h Loewe Volumes: Par BRCA2(−/−) Par BRCA2 (−/−) CX-5461 × Olaparib 1.34 1.32 0.828 1.81

Example 3: Anti-Proliferation Assay

BRCA1 negative (UWB1.289-2945) and BRCA1 positive (UWB1.289) humanovarian cancer cell lines were purchased from the American Type CultureCollection (ATCC). Those cell were incubated in a humidified atmospherecontaining 5% CO₂ at 37° C.

The anticancer activity of Compound A on BRCA1 negative and BRCA1positive human ovarian cancer cell lines were also assessed using invitro cell proliferation assay. Cell proliferation of drug-treated humancancer cell was determined at 72 hours post-treatment using theCellTiter-Glo® Luminescent cell viability assay (Promega). IC₅₀ valuesare defined as the concentration needed for a 50% inhibition of cellgrowth and were calculated in GraphPad. The anti-proliferative effectsof Compound A alone and in combination with cytokines on these two celllines are shown in FIGS. 4-6.

Percentage inhibition of cell growth for compound treatment wascalculated using this formula:

${\%\mspace{14mu}{dead}\mspace{14mu}{cells}} = {100 - \left\lbrack {{luminescent}\mspace{14mu}{value}\mspace{14mu}{in}\mspace{14mu}{treated}\mspace{14mu}{well} \times \frac{100}{{Average}\mspace{14mu}{luminescent}\mspace{14mu}{value}\mspace{14mu}{in}\mspace{14mu}{mock}\mspace{14mu}{control}\mspace{14mu}{well}}} \right\rbrack}$

The data were processed using built-in excel-macro. Cellviability/proliferation was expressed as % dead cells with respect tothe average signal from the untreated control wells of the respectiveplate. Out-liar values (of the triplicate) were rejected during QC. Theprocessed data were plotted using Graphpad software. Statisticalanalysis was done using Excel (Microsoft) and Pair-wise comparison oftwo groups was made using the student's t test. All data represent theresults of triplicate experiments.

As indicated in FIGS. 4 and B, the BRCA1 negative cell line (FIGS. 5A-B)is more sensitive to Compound A than BRCA1 positive cell line (FIGS.4A-B). Compound A inhibited proliferation of BRCA1 negative humanovarian cancer cell lines with IC₅₀ values of around 2.34±1.67 nM to3.78±2.24 nM. In BRCA1 positive ovarian cancer cell line UWB 1.289,Compound A shows a dose dependent trend of cell toxicity. However, themaximum toxicity observed at the highest concentration (100 nM) does notexceed 40%. Therefore, IC₅₀ could not be calculated.

Early studies of CTLA-4 blockade demonstrated that in vivo treatmentinduces the expansion of memory CD8⁺ T-cell populations capable ofproducing intracellular cytokines. Here, two types of cytokines, TNF-αand IFN-γ, were used (0, 0.008, 0.04, 0.2, 1, 5 ng/mL) in response totogether with Compound A.

Both cytokines, TNF-α and IFN-γ, by themselves show minimal, butincreasing trend of cell toxicity with increasing dose on ovarian cancercell lines. Combination drug assays were performed using BRCA1 negativeand BRCA1 positive human ovarian cancer cell lines. In the presence ofCompound A, these two cytokines, TNF-α and IFN-γ, show an additiveeffect on the cell toxicity on BRCA1 negative human ovarian cancercells. The FIGS. 6A-6B shows the dose response curves of the effects ofTNF-α and IFN-γ with various concentrations of Compound A on BRCA1negative cells.

Example 4. Pharmaceutical Combination of Compound a and anImmunotherapeutic Agent

Example 3 shows that in the presence of Compound A, cytokines TNF-α andIFN-γ have an additive cytotoxic effect on BRCA1 negative human ovariancancer cells in a dose-dependent manner. Accordingly, the addition ofanother agent that increases or induces the production of endogenouscytokines in cancer cells should also assist in cancer cell toxicity.

One embodiment of the present invention may thus be a pharmaceuticalcombination comprising a compound of the present invention, such asCompound A, and an immunotherapeutic agent, such as an agent that caninduce the production of endogenous cytotoxic cytokines (e.g., TNF-α andIFN-γ). Such a pharmaceutical combination should have a greater effectin treating or ameliorating cell proliferation disorder. Again, withoutwishing to be bound by any particular theory, we believe animmunotherapeutic agent can increases the local production of one ormore cytokines that have cytotoxic effect on tumor cells, such as tumornecrosis factor α (TNF-α) and Interferon gamma (IFN-γ). Meanwhile, achemical compound described herein, such as Compound A, can enhance thecytotoxic effect of TNF-α and/or IFN-γ, thus the combination can achievegreater therapeutic effect.

Indeed, an anti-PD-1 antibody is capable of enhancing T-cell responsesand cytokine production in vitro. For example, Wang et al. (CancerImmuno Res 2(9): 846-856, incorporated by reference in its entirety)demonstrated that in an allogeneic mixed lymphocyte reaction assay, PD-1blockade with nivolumab (BMS-936558) systematically resulted in atitratable enhancement of IFN-γ release, and in some donor T-cell/DCpairs, enhanced T-cell proliferation was observed. (FIG. 7, adopted fromWang et al.). Using a CMV-restimulation assay, Wang et al. also showedthat nivolumab resulted in a concentration-dependent augmentation ofIFN-γ secretion from CMV-responsive donors.

Our results in Example 3 already demonstrated that TNF-α and IFN-γ showan additive effect on the cell toxicity on BRCA1 negative human ovariancancer cells in the presence of Compound A. Particularly, FIGS. 6A-6Bshow that Compound A can enhance the cytotoxic effect of TNF-α and IFN-γin a dose dependent manner. Therefore, a pharmaceutical combinationcomprising a compound of the present invention, such as Compound A, andan immunotherapeutic agent, such as an agent that can induce theproduction of endogenous cytotoxic cytokines (e.g., TNF-α and IFN-γ)should produce a greater efficiency in killing tumor cells.

The capability of a chemical compound of the present invention, such asCompound A, in increasing production of chemokines in tumor cells wasalso investigated. Chemokines are molecules produced by tumor cellswhich attract immune cells such as effector T-cells. Chemokines andchemokine receptors play a key role along tumor immunogenicity, sincethey not only comprise the main regulatory system leading leukocyteinfiltration in primary tumors, but also intervene in cancer cellsproliferation and in metastasis guidance. Cancer cells, stromal cells,and infiltrated immune cells can secrete chemokines. Cancer cellsthemselves can also express chemokine receptors and respond to thesechemokines. This forms a complex chemokine network that influences tumorcell growth, survival, migration, and angiogenesis, as well as immunecell infiltration.

Compound A was applied to both HBCx-39 (BRCA2 wild type) and HBCx-17(BRCA2 mutant) cancer cell lines in vitro. HBCx-17 is a homologousrecombination deficiency tumor cell line having BRCA2 mutation.Surprisingly, our results demonstrated that Compound A is capable ofinducing the production of several important chemokines in tumor cells(FIGS. 8A to 8C). In addition, Compound A treatment increased more CCL9.CCL21 and CXCL9 mRNA expression in cancer cells having BRCA2 mutantcompared to wild type cancer cells. The results further proved that apharmaceutical combination comprising a compound of the presentinvention, such as Compound A, and an immunotherapeutic agent, such asan agent that can induce the production of endogenous cytotoxiccytokines (e.g., TNF-α and IFN-γ), would have greater efficiency intreating cancer, because the chemokines induced by Compound A attractimmune cells, such as dendritic cells (DCs), activated effector T-cells(e.g., CD8+ lymphocytes), and/or natural killer (NK) cells to tumorcells, and result in destruction of the tumor cells.

The dual functions of a pharmaceutical combination of the presentinvention as explained herein indicate that such pharmaceuticalcombination is surprisingly effective in treating cancers.

Example 5. Pharmaceutical Combination of Compound a and an Anti-PD-1Antibody

Both in vitro and in vivo experiments are conducted to test thepharmaceutical combination comprising Compound A and an anti-PD-1antibody, nivolumab, in treating cancers, such as leukemia, lymphoma,myeloma, multiple myeloma, breast cancer, ovarian cancer, pancreaticcancer, prostate cancer, lung cancer, Ewing's sarcoma, head and neckcancer, heme cancer, colorectum cancer, cervical cancer, liver cancer,cancer of the lymph nodes, colon cancer, prostate cancer, brain cancer,cancer of the head and neck, bone cancer, skin cancer, kidney cancer,and cancer of the heart. In some tests, the cancer is a homologousrecombination (HR) dependent double strand break (DSB) repair deficientcancer or non-homologous end joining (NHEJ) DSB repair deficient cancer.

Compound A and nivolumab are co-administered either in vitro or in vivoto applicable cancer cell lines or patients, with the treatment ofCompound A alone and treatment of the anti-PD-1 antibody alone ascontrols. The results indicate that the pharmaceutical combination showsa synergistic effect in treating cancers when compared to Compound Aalone and the anti-PD-1 antibody treatment alone.

The patents and publications listed herein describe the general skill inthe art and are hereby incorporated by reference in their entireties forall purposes and to the same extent as if each was specifically andindividually indicated to be incorporated by reference. Nothing hereinis to be construed as an admission that the present invention is notentitled to antedate such publication by virtue of prior invention. Inthe case of any conflict between a cited reference and thisspecification, the specification shall control. In describingembodiments of the present application, specific terminology is employedfor the sake of clarity. However, the invention is not intended to belimited to the specific terminology so selected. Nothing in thisspecification should be considered as limiting the scope of the presentinvention. Many modifications and other embodiments of the inventionsset forth herein will come to mind to one skilled in the art to whichthese inventions pertain having the benefit of the teachings presentedin the foregoing descriptions and the associated drawings. All examplespresented are representative and non-limiting. The above-describedembodiments may be modified or varied, without departing from theinvention, as appreciated by those skilled in the art in light of theabove teachings. It is therefore to be understood that, within the scopeof the claims and their equivalents, the invention may be practicedotherwise than as specifically described.

1. A pharmaceutical combination comprising a therapeutically effectiveamount of a compound of formula (I), or a pharmaceutically acceptablesalt, ester, solvate and/or prodrug thereof; and at least one additionaltherapeutically active agent selected from one or more of the groupconsisting of immunotherapeutic agents, anticancer agents, andangiogenic agents; wherein:

X², X³, X⁴, X⁵, X⁶ and X⁷ independently are NR⁴, CH₂, CHQ or C(Q)₂,provided that zero, one or two of X², X³, X⁴, X⁵, X⁶ and X⁷ are NR⁴; Aand V independently are H, halo, azido, —CN, —CF₃, —CONR¹R², —NR⁴R²,—SR², —OR², or —R³; each Q is independently halo, azido, —CN, —CF₃,—CONR¹R², —NR³R², —SR², —OR², or —R³; in each —NR¹R², R¹ and R² togetherwith N may form an optionally substituted azacyclic ring, optionallycontaining one additional heteroatom selected from N, O and S as a ringmember; R¹ is H or C1-C6 alkyl, optionally substituted with one or morehalogens, or ═O; R² is H, or C1-C10 alkyl, C1-C10 heteroalkyl, C2-C10alkenyl, or C2-C10 heteroalkenyl, each of which may be optionallysubstituted with one or more halogens, ═O, or an optionally substituted3-7 membered carbocyclic or heterocyclic ring; R³ is an optionallysubstituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10 aryl, or C6-C12arylalkyl, or a heteroform of one of these, each of which may beoptionally substituted with one or more halogens, ═O, or an optionallysubstituted 3-6 membered carbocyclic or heterocyclic ring; each R⁴ isindependently H, or C1-C6 alkyl; R⁷ is H and R⁸ is C1-C10 alkyl, C1-C10heteroalkyl, C2-C10 alkenyl, or C2-C10 heteroalkenyl, each of which maybe optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-7 membered carbocyclic or heterocyclic ring; orin —NR⁷R⁸, R⁷ and R⁸ together with N may form an optionally substitutedazacyclic ring, optionally containing an additional heteroatom selectedfrom N, O and S as a ring member; m is 0, 1, 2, 3 or 4; n is 0, 1, 2, 3,4, or
 5. 2. The pharmaceutical combination of claim 1, wherein thecompound of formula (I) is represented by formula (II):

wherein: A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R²,—NR¹R², —SR², —OR², or —R³; each Q is independently halo, azido, —CN,—CF₃, —CONR¹R², —NR¹R², —SR², —OR², or —R³; in each —NR¹R², R¹ and R²together with N may form an optionally substituted azacyclic ring,optionally containing an additional heteroatom selected from N, O and Sas a ring member; R¹ is H or C1-C6 alkyl, optionally substituted withone or more halogens, or ═O; R² is H, or C1-C10 alkyl, C1-C10heteroalkyl, C2-C10 alkenyl, or C2-C10 heteroalkenyl, each of which maybe optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-7 membered carbocyclic or heterocyclic ring; R³is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10 aryl,or C6-C12 arylalkyl, or a heteroform of one of these, each of which maybe optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;each R⁴ is independently H, or C1-C6 alkyl; m is 0, 1, 2, 3 or 4; n is0, 1, 2, 3, 4 or 5; and p is 0, 1, 2 or
 3. 3. The pharmaceuticalcombination of claim 1, wherein the compound of formula (I) isrepresented by formula (III):

wherein: A and V independently are H, halo, azido, —CN, —CF₃, —CONR¹R²,—NR¹R², —SR², —OR², or —R³; each Q is independently halo, azido, —CN,—CF₃, —CONR¹R², —NR¹R², —SR², —OR², or —R³; in each —NR¹R², R¹ and R²together with N may form an optionally substituted azacyclic ring,optionally containing an additional heteroatom selected from N, O and Sas a ring member; R¹ is H or C1-C6 alkyl, optionally substituted withone or more halogens, or ═O; R² is H, or C1-C10 alkyl, C1-C10heteroalkyl, C2-C10 alkenyl, or C2-C10 heteroalkenyl, each of which maybe optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-7 membered carbocyclic or heterocyclic ring; R³is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10 aryl,or C6-C12 arylalkyl, or a heteroform of one of these, each of which maybe optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;each R⁴ is independently H, or C1-C6 alkyl; R⁷ is H and R⁸ is C1-C10alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10 heteroalkenyl, eachof which may be optionally substituted with one or more halogens, ═O, oran optionally substituted 3-7 membered carbocyclic or heterocyclic ring;m is 0, 1, 2, 3 or 4; and n is 0, 1, 2, 3, 4 or
 5. 4. The pharmaceuticalcombination of claim 3, wherein the Compound is Compound A:


5. The pharmaceutical combination of claim 1, wherein the compound offormula (I) and the at least one additional therapeutically active agentare in single dosage form or in separate dosage forms.
 6. Thepharmaceutical combination of claim 5, wherein the separate dosage formsare administered via same mode of administration or different modes ofadministration.
 7. The pharmaceutical combination of claim 6, whereinthe separate dosage forms are co-administered via simultaneousadministration, sequential administration, overlapping administration,interval administration, continuous administration, or a combinationthereof.
 8. The pharmaceutical combination of claim 1, wherein the atleast one additional therapeutically active agent comprises at least oneimmunotherapeutic agent.
 9. The pharmaceutical combination of claim 8,wherein the at least one immunotherapeutic agent is selected from one ormore of the group consisting of: monoclonal antibody, an immune effectorcell, adoptive cell transfer, an immunotoxin, a vaccine, or a cytokine.10. The pharmaceutical combination of claim 8, wherein the at least oneimmunotherapeutic agent is an antibody or an antigen-binding portionthereof that disrupts the interaction between Programmed Death-1 (PD-1)and Programmed Death Ligand-1 (PD-L1).
 11. The pharmaceuticalcombination of claim 8, wherein the at least one immunotherapeutic agentis selected from one or more of the group consisting of: an anti-PD-1antibody, a PD-1 antagonist, an anti-PD-L1 antibody, a siRNA targetingexpression of PD-1, a siRNA targeting the expression of PD-L1, and apeptide, fragment, dominant negative form, or soluble form of PD-1 orPD-L1.
 12. The pharmaceutical combination of claim 11, wherein theanti-PD-1 antibody is a monoclonal antibody.
 13. The pharmaceuticalcombination of claim 11, wherein the anti-PD-1 antibody is a humanizedantibody.
 14. The pharmaceutical combination of claim 8, wherein the atleast one immunotherapeutic agent is selected from one or more of thegroup consisting of a CTLA-4 antagonist, an anti-CTLA-4 antibody, asiRNA targeting the expression of CTLA-4, and a peptide, fragment,dominant negative, or soluble form of CTLA-4.
 15. The pharmaceuticalcombination of claim 9, wherein the monoclonal antibody is selected fromone or more of the group consisting of anti-PD-1 antibody, nivolumab,pembrolizumab alemtuzumab, bevacizumab, brentuximab vedotin, cetuximab,gemtuzumab ozogamicin, ibritumomab tiuxetan, ipilimumab, ofatumumab,panitumumab, rituximab, tositumomab, trastuzumab, anti-B7-H4,anti-B7-H1, anti-LAG3, BTLA, anti-Tim3, anti-B7-DC, anti-CD160, MRantagonist antibodies, anti-4-1BB, anti-OX40, anti-CD27, and CD40agonist antibodies.
 16. The pharmaceutical combination of claim 15,wherein the monoclonal antibody is selected from the group consisting ofnivolumab and pembrolizumab.
 17. The pharmaceutical combination of claim16, wherein the monoclonal antibody is nivolumab.
 18. The pharmaceuticalcombination of claim 1, wherein the at least one additionaltherapeutically active agent comprises at least one anticancer agent.19. The pharmaceutical combination of claim 18, wherein the at least oneanticancer agent is selected from one or more of the group consisting ofan alkylating agent, an anti-metabolite, a vinca alkaloid, a taxane, atopoisomerase inhibitor, an anti-tumor antibiotic, a tyrosine kinaseinhibitor, an immunosuppressive macrolide, an Akt inhibitor, an HDACinhibitor an Hsp90 inhibitor, an mTOR inhibitor, a PI3K/mTOR inhibitor,a PI3K inhibitor, a CDK (cyclin-dependent kinase) inhibitor, CHK(checkpoint kinase) inhibitor, and PARP (poly (DP-ribose)polymerase)inhibitors.
 20. The pharmaceutical combination of claim 18, wherein theat least one anticancer agent is a PI3K inhibitor.
 21. Thepharmaceutical combination of claim 19, wherein the PI3K inhibitor isIdelalisib.
 22. The pharmaceutical combination of claim 18, wherein theat least one anticancer agent is a PARP inhibitor.
 23. Thepharmaceutical combination of claim 22, wherein the PARP inhibitor isOlaparib.
 24. The pharmaceutical combination of claim 1, wherein the atleast one additional therapeutically active agent comprises at least oneanti-angiogenic agent.
 25. The pharmaceutical combination of claim 25,wherein the at least one anti-angiogenic is selected from one or more ofthe group consisting of 2-methoxyestradiol, AG3340, prinomastat,batimastat, BAY 12-9566, carboxyamidotriazole, CC-1088, dextromethorphanacetic acid, dimethylxanthenone acetic acid, EMD 121974, endostatin,IM-862, marimastat, matrix metalloproteinase, penicillamine, PTK787/ZK222584, RPI.4610, squalamine, squalamine lactate,3-[2,4-dimethylpyrrol-5-yl-methyl-idenyl]-2-indolinone (SU5416),(±)-thalidomide, S-thalidomide, R-thalidomide,0-(chloroacetylcarbamoyl)fumagillol (TNP-470), combretastatin,paclitaxel, tamoxifen, COL-3, neovastat, BMS-275291, SU6668, 2-ME,interferon-alpha, anti-VEGF antibody, Medi-522 (Vitaxin II), CAI(inhibitor of calcium influx), celecoxib, Interleukin-12, IM862,amilloride, Angiostatin® protein, angiostatin K1-3, angiostatin K1-5,captopril, DL-alpha-difluoromethylornithine,DL-alpha-difluoromethylornithine HCl, His-Tag® Endostatin™ Protein,fumagillin, herbimycin A, 4-hydroxyphenylretinamide, gamma-interferon,juglone, laminin, laminin hexapeptide, laminin pentapeptide, lavendustinA, medroxyprogesterone, medroxyprogesterone acetate, minocycline,minocycline HCl, placental ribonuclease inhibitor, suramin, sodium saltSuramin, human platelet thrombospondin, tissue inhibitor ofmetalloproteinase 1, neutrophil granulocyte tissue inhibitor ofmetalloproteinase 1, or rheumatoid synovial fibroblast tissue inhibitorof metalloproteinase
 2. 26. The pharmaceutical combination of claim 1,which is a pharmaceutical formulation further comprising apharmaceutically acceptable excipient or a pharmaceutically acceptablecarrier.
 27. The pharmaceutical combination of claim 4, wherein CompoundA is present in an amount from about 1 mg to about 500 mg.
 28. Thepharmaceutical combination of claim 1, wherein the compound is CompoundA:

and wherein the at least one additional therapeutically active agent isselected from one or more of the group consisting of a PARP inhibitorand an anti-PD-1 antibody.
 29. The pharmaceutical combination of claim28, wherein the PARP inhibitor is Olaparib.
 30. The pharmaceuticalcombination of claim 28, wherein the anti-PD-1 antibody is nivolumab.31. A method for treating or ameliorating cell proliferation disorder ina subject, the method comprising administering to a subject in needthereof a therapeutically effective amount of a compound of formula (I);

or a pharmaceutically acceptable salt, ester, solvate and/or prodrugthereof; wherein: X¹ is CH or N; X², X³, X⁴, X⁵, X⁶ and X⁷ independentlyare NR⁴, CH₂, CHQ or C(Q)₂, provided that zero, one or two of X², X³,X⁴, X⁵, X⁶ and X⁷ are NR⁴; A and V independently are H, halo, azido,—CN, —CF₃, —CONR¹R², —NR¹R², —SR², —OR², or —R³; each Q is independentlyhalo, azido, —CN, —CF₃, —CONR¹R², —NR¹R², —SR², —OR², or —R³; in each—NR¹R², R¹ and R² together with N may form an optionally substitutedazacyclic ring, optionally containing one additional heteroatom selectedfrom N, O and S as a ring member; R¹ is H or C1-C6 alkyl, optionallysubstituted with one or more halogens, or ═O; R² is H, or C1-C10 alkyl,C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10 heteroalkenyl, each ofwhich may be optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-7 membered carbocyclic or heterocyclic ring; R³is an optionally substituted C1-C10 alkyl, C2-C10 alkenyl, C5-C10 aryl,or C6-C12 arylalkyl, or a heteroform of one of these, each of which maybe optionally substituted with one or more halogens, ═O, or anoptionally substituted 3-6 membered carbocyclic or heterocyclic ring;each R⁴ is independently H, or C1-C6 alkyl; R⁷ is H and R⁸ is C1-C10alkyl, C1-C10 heteroalkyl, C2-C10 alkenyl, or C2-C10 heteroalkenyl, eachof which may be optionally substituted with one or more halogens, ═O, oran optionally substituted 3-7 membered carbocyclic or heterocyclic ring;or in —NR⁷R⁸, R⁷ and R⁸ together with N may form an optionallysubstituted azacyclic ring, optionally containing an additionalheteroatom selected from N, O and S as a ring member; m is 0, 1, 2, 3 or4; n is 0, 1, 2, 3, 4, or 5; and administering radiotherapy or at leastone additional therapeutically active agent before, during, or after thesubject has been administered a compound of formula (I).
 32. The methodof claim 31, wherein the cell proliferation disorder is cancer.
 33. Themethod of claim 32, wherein the cancer is selected from the groupconsisting of: heme cancer, colorectum cancer, ovarian cancer, breastcancer, cervical cancer, lung cancer, liver cancer, pancreatic cancer,cancer of the lymph nodes, colon cancer, prostate cancer, brain cancer,cancer of the head and neck, bone cancer, Ewing's sarcoma, skin cancer,kidney cancer, and cancer of the heart.
 34. The method of claim 32,wherein the cancer is selected from the group consisting of wherein thecancer is selected from the group consisting of breast cancer, ovariancancer, pancreatic cancer, prostate cancer, lung cancer, Ewing'ssarcoma, head and neck cancer, and cervical cancer.
 35. The method ofclaim 33, wherein the heme cancer is selected from the group consistingof: leukemia, lymphoma, myeloma, and multiple myeloma.
 36. The method ofclaim 32, wherein the cancer is homologous recombination (HR) dependentdouble strand break (DSB) repair deficient cancer or non-homologous endjoining (NHEJ) DSB repair deficient cancer.
 37. The method of claim 33,wherein the subject is human.
 38. The method of claim 33, wherein theone or more additional therapeutic agent is selected from one or more ofthe group consisting of immunotherapeutic agents, anticancer agents, andangiogenic agents.
 39. The method of claim 31, wherein the Compound isCompound A:


40. The method of claim 39, wherein the at least one additionaltherapeutically active agent is selected from one or more of the groupconsisting of a PARP inhibitor and an anti-PD-1 antibody.
 41. The methodof claim 40, wherein the PARP inhibitor is Olaparib.
 42. The method ofclaim 40, wherein the anti-PD-1 antibody is nivolumab.